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Individuals with Chronic Obstructive Pulmonary Disease (COPD) experience sleep disturbances due to the impact of respiratory symptoms on sleep quality. We explored whether sleep disturbances in COPD are linked to heterogeneity of airway constriction.The impact of breathing problems on sleep quality was measured in consecutive COPD outpatients with the COPD and Asthma Sleep Impact Scale (CASIS) questionnaire. Impulse oscillometry technique (IOS) was employed to assess heterogeneity of airway constriction. Subjects with a previous or concomitant diagnosis of asthma or obstructive sleep apnea (OSA) were excluded.Fifty COPD subjects (M/F 40/10; age: 71 +/- 8 yrs, Body Mass Index (BMI): 26.2 +/- 4.7 kg/m(2), Forced Expiratory Volume in the first second (FEV1): 65 +/- 25% predicted; mean +/- SD) were enrolled. The mean CASIS score was 36 +/- 3.3, and the R5-R20 value was 0.2 +/- 0.15 kPa s L-1. The CASIS score was significantly higher in subjects with increased R5-R20 (>0.07 kPa s L-1) (39 +/- 24; p = 0.02) compared to normal R5-R20 (21 +/- 17). When subjects were categorized on the basis of lung function in severely versus non severely obstructed (FEV1 50% predicted) or air trappers versus non air trappers (Residual Volume, RV >= or

Background: Patients on home continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) show large variability in compliance to treatment. Aim: To identify predictors of poor compliance, we evaluated compliance to treatment in patients with obstructive sleep apnea (OSA), obesity hypoventilation syndrome (OHS), and OSA-chronic obstructive pulmonary disease (COPD) overlap syndrome. Methods: We analyzed clinical and compliance data provided by a single home care provider, in 602 patients (n=442 OSA, males (M) 308; 38 OHS M=15, and 122 overlap M=111) on home CPAP/NIV in the province of Agrigento, Italy, after one year of treatment. The following variables were considered: age, body mass index (BMI), sex, diagnosis, type of prescribed ventilator, and common comorbidities. Results: Mean (±SD) age and BMI were: 64.6±11.9 yrs, and 34.4±7.3 kg/m2. CPAP was prescribed in 67.1%, AutoCPAP in 12.9%, Bilevel in 9.1%, and volume assured pressure support ventilation in 10.9% of the sample. Mean compliance to treatment was 4.7±2.7 h/day, with 64.3% of the patients showing good compliance (>4 h/night). Patients overestimated CPAP/NIV use by 0.5 h/night. Compliance was not affected by age, diagnosis, severity of sleep disordered breathing, type of ventilation or occurrence of comorbidities, with the exception of depression (p=0.05). BMI was higher in poorly compliant compared to compliant patients (p=0.02). When data were split by gender, compliance was OHS>OSAS>overlap in women (p 0.007); overlap>OSAS>OHS in men (p=0.013) Conclusions: A high degree of obesity and depression were associated with poor compliance to ventilatory treatment.

Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.

Air pollution is a major problem worldwide, which could be even more serious for athletes who train in urban environments. Exercise increases minute ventilation and exposure to pollutants, but the literature on the effects of air pollution in athletes is relatively scarce, with the exception of chlorine exposure in athletes of aquatic sports and air pollution secondary to ice resurfacing in athletes performing in ice arenas. Although air pollution may exert detrimental effects on athletic performance, little has been published on this topic. The largest body of information regards the impact of air pollution during urban active transport, i.e., walking and cycling in cities, due to the potential risk of air pollution in citizens and the need to rethink urban transportation strategies accordingly. In healthy subjects, the benefits of physical activity largely outweigh the disadvantages of exposure to air pollutants. In susceptible individuals, however, such as patients with cardiac or respiratory disease and children, detrimental effects have been demonstrated. Improvement in air quality, individual protective behaviors, and prompt communication to the population of dangerous air quality may help to limit the negative effects of air pollution on respiratory health.

Continuous positive airway pressure (CPAP) is the first-choice treatment for obstructive sleep-disordered breathing. Automatic bilevel ventilation can be used to treat obstructive sleep-disordered breathing when CPAP is ineffective, but clinical experience is still limited. To assess the outcome of titration with CPAP and automatic bilevel ventilation, the charts of 356 outpatients (obstructive sleep apnea, n = 242; chronic obstructive pulmonary disease + obstructive sleep apnea overlap, n = 80; obesity hypoventilation syndrome [OHS], n = 34; 103 females) treated for obstructive sleep-disordered breathing from January 2014 to April 2017 were reviewed. Positive airway pressure titration was considered successful in the case of sleep-disordered breathing resolution (apnea-hypopnea index 40 kg/m2(odds ratio 6.16, confidence interval 1.50-25.17, p = 0.011) and CT90% >42% (odds ratio 5.87, confidence interval 1.39-24.83, p = 0.016). During follow-up, automatic bilevel ventilation treatment failed in seven patients (10%), and compliance was similar in CPAP (4.5 ± 2.2 hr) and automatic bilevel ventilation (5.2 ± 2.3 hr, p = 0.09) groups. Automatic bilevel ventilation was useful to treat sleep-disordered breathing, but failed in patients with severe OHS.

Background: Individuals with COPD experience sleep disturbances due to the impact of symptoms on quality of sleep. Aim: To test the hypothesis that, in COPD, sleep disturbances are linked to peripheral airway abnormalities. Methods: An investigational study is being performed at the University of Palermo, Italy. The impact of breathing problems on quality of sleep during the previous week is measured with the COPD and Asthma Sleep Impact Scale (CASIS) questionnaire. Airway resistances by impulse oscillometry (IOS) assesses peripheral airway abnormalities. Lung function evaluation includes static and dynamic lung volume measurements. To rule out the risk of having obstructive sleep apnea, the Epworth Sleepness Scale (ESS) and nocturnal oximetry is performed. Results: To date, 29 COPD subjects (M/F: 25/4, age: 72±8 yrs, BMI: 26.3±4.5 kg/m2, FEV1: 65±11% predicted; mean±SD) have been enrolled. In this interim analysis, the CASIS score was 33 (range: 0-86), and R5-R20 was 0.16±0.09 kPasL-1. Subjects with abnormal peripheral airway resistances (R5-R20>0.07 kPasL-1) had a significantly higher CASIS score than those with R5-R20≤0.07 kPasL-1 (38.9±29 vs 16.6±16, respectively; p=0.049). The CASIS score was not associated with the degree of airway obstruction (FEV1≤50% and >50% predicted: 38±30 vs. 30±27, p=0.48), or the magnitude of air trapping (residual volume >120% and ≤120% predicted: 25±25 vs 39±27, p=0.22). EES and nocturnal oximetry were within normal ranges. Conclusions: Preliminary results indicate that a relationship exists between sleep disturbances due to COPD symptoms and peripheral airway abnormalities. The final analysis will allow better description of this association.

CPAP is the first-choice treatment for obstructive SDB, but the criteria to prescribe AutoBI are undefined. Trials of AutoBI ventilation in patients under titration for obstructive SDB from January 2015 to January 2017 ((n=67 out of 265 titrations) were reviewed to assess: a) their clinical features, b) the reason to shift from CPAP to AutoBI, and c) long-term compliance to treatment. AutoBI was used in cases of intolerance to high therapeutic CPAP levels (n=23) or incomplete resolution of SDB on CPAP (n=45). AutoBI failed in 11 patients (16.4%): 2 OSA patients (7.7%), 4 overlap patients (21%), and 5 OHS patients (22.7%). The Table reports the differences at diagnosis between patients prescribed CPAP or AutoBI (unpaired t-test, significance p

CPAP is the first-choice treatment for obstructive sleep-disordered breathing (O-SDB), while the criteria to prescribe AutoBI are undefined. Trials of AutoBI ventilation in patients (pts) treated for O-SDB from January 2015 to October 2016 (64 out of 242 titrations) were reviewed to assess: a) the clinical characteristics of these pts, b) the reason to shift from CPAP to AutoBI, c) the compliance to prescribed treatment. AutoBI was used in cases of intolerance to high therapeutic CPAP levels (n=21) or incomplete resolution of SDB on CPAP (n=43). The Table reports the differences between CPAP or AutoBI pts CPAP SDB diagnosis was: 82% OSA, 18% OSA-COPD Overlap in the CPAP group; 39% OSA, 28% OSA-COPD Overlap and 33% OHS in the AutoBI group (p In conclusion, AutoBi can be considered an effective and well-tolerated treatment in pts with obstructive SDB, especially in cases with severe obesity, nocturnal hypoventilation, or needing high therapeutic pressures.

Automatic bilevel ventilation (AutoBI) has been recently introduced to treat obstructive sleep-disordered breathing (SDB), but clinical experience is still limited. We revised the charts of patients treated for obstructive SDB in our sleep clinic in 2015 (n=214) to assess the frequency of trials of AutoBI ventilators (ResMed Auto25 or Respironics BiFlex), the clinical characteristics of these patients, the reason to shift from CPAP to AutoBI, and the outcome of AutoBI titration. A trial of domiciliary AutoBI was made in 44 patients (20.5%) intolerant to CPAP due to high CPAP levels (n=11) or who showed incomplete resolution of SDB on CPAP (n=33). The table reports the clinical data according to diagnosis. AutoBi was successful (i.e. resolution of SDB and improved CT90%/daytime arterial blood gases) in 34 patients (77%), and failed in 10 patients (4 OHS, 3 OSA and 3 overlap). Patients successfully treated were significantly less obese (BMI 37.9±6.8 kg/m 2 ) than patients showing failure of AutoBi (n=10, BMI 50.2±20.1 kg/m 2 , p=0.0035). Failure of AutoBi was mostly seen among patients with incomplete resolution of SDB, only one overlap patient being intolerant to high CPAP pressure. Our results suggest that AutoBi is an effective alternative treatment in patients with obstructive SDB, especially in patients intolerant to high CPAP and without extreme obesity or COPD.

Sleep disordered breathing (SDB) is often overlooked in hospitalized patients. We screened consecutive patients with cardiovascular (CV) comorbidities hospitalized for respiratory problems to study SDB prevalence and type. Patients did not refer typical clinical signs of SDB. Patients (n=34, 21 M, mean age±SD 71±12 yr, BMI: 31.9±5.8 kg/m2) were studied by polygraphy (SomnoLab, Weinmann, Germany) 4.5±3.2 days after admission for COPD exacerbation (COPD-E, n=20), pleural effusion (n=2), asthma exacerbation (n=2) or other causes (n=10). On admission, 18 patients showed respiratory failure (RF, hypoxemic: n=9, hypercapnic: n=9). CV comorbidities (1.7±0.8/patient) were: hypertension (n= 27), heart failure (n=3), arrhythmias (n=11), coronary artery (n=15) or cerebrovascular (n=3) disease. Results showed: AHI≤5 (n=5, 14.7%), AHI≤15+nocturnal hypoxemia (n=3, 8.8%), obstructive (n=16, 47.1%), and central/complex SDB (n=10, 29.4%). Mean AHI was higher in the latter group (28.0±14.5/h) compared to patients with obstructive SDB (15.0±14.0/h), nocturnal hypoxemia (6.3±2.4/h) or AHI≤5 (3.1±1.0/h, p=0.005 by ANOVA). SDB type and severity were similar in men and women, and distribution of SDB type was unaffected by COPD-E or RF. The number of CV comorbidities tended to be highest in patients with central/complex SDB, and lowest in those with nocturnal hypoxemia (p=0.08 by ANOVA, NS). Therefore, 76% of patients with CV comorbidities hospitalized for respiratory problems showed obstructive or central/complex SDB. Central SDB were more severe but less frequent than obstructive SDB, and female gender did not protect against SDB in this population. Funded by ERS STRTF 5329-2013.

In this work we analysed, by immunohistochemistry, a series of brain tumors to detect the levels and cellular distribution of Hsp60 and Hsp70. We found that Hsp60 levels were significantly higher than those of Hsp70 in neuroepithelial tumors, while levels of both molecules were not significantly different from each other in meningeal neoplasms. In particular, Hsp60 immunopositivity was present mainly at the cytoplasmic level, while Hsp70 immunopositivity was found both in the cytoplasm and in the nucleus of tumor cells. The levels of these molecules in healthy control cells were always very low. Finally, Hsp60 and Hsp70 levels did not correlate with the different types (WHO grade) of neoplasm. Our results are partially in agreement with previous studies and suggest that Hsp60 is not increased by a passive phenomenon (e.g., due to the stress caused by the peritumor environment on cancer cells) but may be actively implicated in tumor progression, e.g. inhibiting tumor cell death or antitumor immune system response, as already postulated in vitro. We also briefly discuss the most recent publications on the extramitochondrial localization of Hsp60 in tumor cells and its role in tumor progression.