Risultati per: Prima terapia farmacologica per l’apnea notturna (OSAS)

Stroke, Volume 54, Issue 12, Page 3141-3152, December 1, 2023. BACKGROUND:Sleep apnea (SA) is a major threat to physical health and carries a significant economic burden. These impacts are worsened by its interaction with, and induction of, its comorbidities. SA holds a bidirectional relationship with hypertension, which drives atherosclerosis/arteriolosclerosis, ultimately culminating in vascular dementia.METHODS:To enable a better understanding of these sequelae of events, we investigated innate SA and its effects on cognition in adult-aged spontaneously hypertensive rats, which have a range of cardiovascular disorders: plethysmography and electroencephalographic/electromyographic recordings were used to assess sleep-wake state, breathing parameters, and sleep-disordered breathing; immunocytochemistry was used to assess vascular and neural health; the forced alteration Y maze and Barnes maze were used to assess short- and long-term memories, respectively; and an anesthetized preparation was used to assess baroreflex sensitivity.RESULTS:Spontaneously hypertensive rats displayed a higher degree of sleep-disordered breathing, which emanates from poor vascular health leading to a loss of preBötzinger Complex neurons. These rats also display small vessel white matter disease, a form of vascular dementia, which may be exacerbated by the SA-induced neuroinflammation in the hippocampus to worsen the related deficits in both long- and short-term memories.CONCLUSIONS:Therefore, we postulate that hypertension induces SA through vascular damage in the respiratory column, culminating in neuronal loss in the inspiratory oscillator. This induction of SA, which, in turn, will independently exacerbate hypertension and neural inflammation, increases the rate of vascular dementia.

Il nuovo farmaco Casgevy è prodotto da Vertex Pharmaceuticals Ltd. e CRISPR Therapeutics. Fino ad oggi, il trapianto di midollo osseo, procedura estremamente faticosa che comporta effetti collaterali molto spiacevoli, è stato l’unico trattamento di lunga durata per la talassemia

Sperimentazione dell’Aou “G. Martino” di Messina

Circulation, Volume 148, Issue Suppl_1, Page A12622-A12622, November 6, 2023. Introduction:Central sleep apnea (CSA) is closely associated with poor prognosis in heart failure (HF) patients. Adaptive servo-ventilation (ASV) was expected as a new treatment for HF patients with CSA. However, the efficacy of ASV is controversial, especially the efficacy of long-term use has remained unclear.Methods:We retrospectively examined all HF patients with CSA treated with ASV seen between May 2008 and November 2022 in our hospital who had not been admitted to the hospital due to worsening HF in the 6 months before initiating ASV therapy. We divided them into 2 groups: (A) non-continues-ASV-treated patients; (B) continues-ASV-treated patients. The outcome was a composite of readmission due to worsening HF and all-cause mortality.Results:During a median follow-up of 10.3 years after leaving the hospital, 11 patients died out of 101 patients. Twenty-two patients (group A) could not continue to use ASV because of its discomfort. Seventy-nine patients (group B) could continue to use the ASV device at night after leaving the hospital over a long period. There were almost no significant differences in the baseline characteristics between the two groups. In group B, during 6-, 12-, and 24-month observations, left ventricular ejection fraction (46.4 +/- 17.9 to 47.1 +/- 15.6, 49.8 +/- 15.8, and 48.2+/- 18.9%, p

Circulation, Volume 148, Issue Suppl_1, Page A13984-A13984, November 6, 2023. Background:Obstructive sleep apnea (OSA), prevalent in patients with heart failure (HF) and those with coronary heart disease (CHD), is associated with poor quality of life (QoL) but underlying mechanisms are not well understood. Depressive symptoms and low perceived control, also common in these patients, may explain associations between OSA and QoL.Objective:To determine whether depressive symptoms and perceived control mediate the association of OSA with QoL among patients with HF or CHD.Method:We performed a serial mediation analysis using baseline data from an ongoing randomized comparative effectiveness trial from 222 adults with HF or CHD (male: 55%, age: 59±13 years, married: 65%). Obstructive sleep apnea was measured using the STOP-BANG that included information onsnoring,tiredness,observed apnea, high bloodpressure,body mass index,age,neck circumference, andgender. Depressive symptoms were measured using the Patient Health Questionnaire-9. Perceived control was measured using the Control Attitude Scale-Revised (CASR). Quality of life was measured using the Functional Outcomes of Sleep Questionnaire. The analysis was conducted using PROCESS (Model 6) for SPSS.Results:Ninety-nine (45%) of participants had OSA. Obstructive sleep apnea wasindirectlyassociated with QoL through the following paths: 1) depressive symptoms; 2) perceived control; 3) serially through both depressive symptoms and perceived control (Figure), indicating a mediating role for depressive symptoms and perceived control in the association of OSA with QoL.Conclusion:Because the relationship between OSA and poor QoL is mediated by depressive symptoms and perceived control, it is critical to screen patients for these conditions. As important, interventions need to be developed to reduce depressive symptoms and improve perceived control in order to improve patients’ QoL.

Circulation, Volume 148, Issue Suppl_1, Page A15816-A15816, November 6, 2023. Background:End-stage renal disease (ESRD) patients with more intensive renal replacement therapy have been shown to alleviate the severity of sleep apnea, specifically obstructive sleep apnea (OSA). Our study aims to analyze the trends in combined cardiovascular events among geriatric CKD patients, comparing those with and without OSA.Methods:We conducted a comprehensive analysis using nationwide data from 2016 to 2019 to identify geriatric CKD patients based on ICD-10 codes. A comparative assessment was performed between elderly CKD patients with and without OSA, examining their baseline characteristics and potential disparities related to sex and race.Results:From 2016 to 2019, 14,157,877 geriatric CKD patients were analyzed. OSA is more prevalent in men (60.5% v/s 50.5%) and in the white race(79.3% v/s 72.5%) compared to the non-OSA group. In the OSA group, men had an increased prevalence of major adverse cardiovascular and cerebrovascular events (MACCE) (12.0% v/s 9.7%) and acute myocardial infarction (AMI)(7.0%-5.2%) with p

Circulation, Volume 148, Issue Suppl_1, Page A12619-A12619, November 6, 2023. Introduction:Obstructive sleep apnea (OSA), a common sleep disorder, has been associated with the risk of atrial fibrillation (AF). OSA is a heterogenous condition but is heavily position-dependent. Positional OSA (POSA) is a common form of OSA in which OSA is predominantly manifested in a supine position. The implication of POSA in cardiovascular risks is unclear. This study aimed to examine whether the risk of AF is different between individuals with POSA and those with non-positional OSA (nPOSA).Methods:We identified individuals with OSA (AHI ≥ 5/h) from the Sleep Heart Health Study (SHHS) cohort. POSA was defined if overall AHI ≥ 5/h, supine AHI ≥ 5/h, and supine AHI greater than twice the non-supine AHI based on the SHHS visit 1 sleep study. Incident AF was deemed present if detected on a 12-lead ECG during the SHHS visit 2 or confirmed by the parent cohorts at any time between the baseline PSG and the final follow-up date for AF assessment. Multiple logistic regression analysis was conducted with covariates including age, race, gender, body mass index, smoking status, systolic blood pressure, use of hyperlipidemia medication, use of diabetes medication (oral or insulin), use of hypertension medication, cholesterol, triglyceride, and high-density-lipoprotein, and other sleep characteristics (total sleep duration, sleep efficiency, and sleep onset latency).Results:The study included a total of 1712 participants (females, 45%; mean age, 65 years old) with OSA. Compared with individuals with nPOSA, those with POSA were more likely to be white (p=.002), older (p

Circulation, Volume 148, Issue Suppl_1, Page A18192-A18192, November 6, 2023. Introduction:In younger individuals, the factors contributing to atrial fibrillation (AF) and ischemic stroke are not entirely understood. Despite the frequent coexistence of obstructive sleep apnea (OSA) and AF, current guidelines do not advise routine screening for either condition.Hypothesis:OSA may be an independent predictor of AF in younger adultsMethods:We mined electronic health records of patients aged 20-50 Y who have had >=2 visits within Stanford Healthcare System during the period of 2008 to 2022. Our primary endpoint was incident AF. A comprehensive list of risk factors was mined as covariates. Time-varying covariate survival analysis was done to relate the covariates to the primary endpoint. Analysis was performed in R.Results:From a total population of approximately 1.3 million patients aged between 20 and 50 years, we identified 541168 individuals. Among them, 66088 (12.2%) had OSA. During the follow-up, 5060 young adults (67 per 100,000 person-years) developed new AF. In the multivariable adjusted time-varying analysis, apart from previously reported cardiovascular and demographic risk factors, sleep apnea [aHR:1.13 (1.06,1.20)], CKD [aHR:1.91 (1.22,1.44)], cancer [aHR:1.12, (1.04,1.20)], chronic liver disease [aHR:1.13, (1.05,1.21)] were independent risk factors of AF (Fig 1a). Although risk portended by sleep apnea may be slightly lower than some CHADS2VASC factors, sleep apnea is much more prevalent than them, which may support the benefit for screening in this young population (Fig 1b).Conclusions:In a cohort of over half a million adults aged between 20 and 50, sleep apnea significantly and independently predicts incident AF, which may have implications in screening and treatment strategies for younger patients.

Circulation, Volume 148, Issue Suppl_1, Page A18921-A18921, November 6, 2023. Introduction:Heart failure with preserved ejection fraction (HFpEF) is often accompanied by obstructive sleep apnea (OSA). The effects of HFpEF on OSA pathophysiology remain relatively unexplored. Pulmonary congestion and sympathetic nervous activity (SNA) may drive ventilatory control instability (high loop gain [LG]). Elevated SNA also theoretically predisposes sleep to easier interruption by breathing events of OSA, reflected by low arousal threshold (ArTH).Hypothesis:In comparison to patients with OSA alone, patients with both OSA and HFpEF have higher LG and lower ArTH.Methods:We reviewed records to include patients with 1) transthoracic echocardiography with EF >40% and left ventricular diastolic dysfunction by decreased age-adjusted e’ and/or left atrial volume index >28 mL/m2; 2) OSA by apnea-hypopnea index (AHI3A) ≥15 events/hour; and 3) raw polysomnography (PSG) data available for advanced signal analysis. LG and ArTH were estimated by Phenotyping Using Polysomnography (PUP), a MATLAB algorithm that quantifies pathophysiologic mechanisms of OSA using PSG data. Values in HFpEF+OSA patients were compared to values from research volunteers with OSA alone.Results:The HFpEF+OSA group included 21 patients. The OSA alone group included 43 research volunteers. LG was lower for HFpEF+OSA (0.63±18) compared to OSA alone (0.69±18), but the difference was not statistically significant. ArTH was significantly lower for HFpEF+OSA (117.0±15.9 %eupnea) compared to OSA alone (152.8±54.8 %eupnea, p =

Circulation, Volume 148, Issue Suppl_1, Page A18481-A18481, November 6, 2023. Introduction:Autonomic nervous system (ANS) dysfunction is implicated in sleep-disordered breathing (SDB) and atrial fibrillation (AF).Hypothesis:We hypothesize that ANS measures of heart rate variability (HRV) exhibit diurnal differences in paroxysmal AF(PAF) relative to SDB severity and is impacted by continuous positive airway pressure (CPAP).Methods:Data from the Sleep Apnea and Atrial Fibrillation Biomarkers and Electrophysiologic Atrial Triggers (SAFEBEAT) study including PAF (7-24 day ECG monitoring), concomitant actigraphy and SDB from polysomnography at baseline and 3-months post-CPAP were analyzed. Linear mixed-effects models were used to assess SDB (apnea hypopnea index (AHI), hypoxia (%sleep time with SaO2

Circulation, Volume 148, Issue Suppl_1, Page A14281-A14281, November 6, 2023. Background:While heart failure with preserved ejection fraction (HFpEF) is highly associated with the presence of sleep apnea, few studies have examined the association between diagnostic scoring systems used to predict HFpEF risk, such as the H2FPEF score, and OSA prevalence and severity.Methods:We performed a retrospective chart review on all patients (N = 434) who underwent both an echocardiogram and a sleep study at the University of Pennsylvania between July 1, 2020, and June 30, 2022. Associations between echocardiographic parameters and OSA severity, as well as between H2FPEF score and OSA severity, were examined using linear tests of trend. The association between H2FPEF score categorization and odds of prevalent OSA was examined with logistic regression.Results:OSA severity was associated with echocardiographic markers of diastolic dysfunction including greater LV mass index (p = 0.04), left atrial volume index (p = 0.03), and LV relative thickness (p = 0.008). Patients with intermediate H2FPEF risk scores had 4.3 times greater odds of prevalent OSA compared with those patients with low risk H2FPEF scores (95% CI 2.2, 8.7, p < 0.001). Patients with high H2FPEF risk scores had over 17-fold higher odds of prevalent OSA compared to those with low-risk scores (17.7, 95% CI 4.3, 120.7, p < 0.001) (Figure 1). Increasing risk of HFpEF according to H2FPEF categorization was strongly correlated with OSA severity as measured by apnea-hypopnea index (p < 0.001) and oxygen desaturation index (p = 0.002).Conclusions:In an ambulatory population referred for both sleep study and echocardiogram, markers of diastolic dysfunction were associated with OSA severity. OSA prevalence and severity were strongly associated with increased H2FPEF scores. Clinicians should have a low threshold for referring OSA patients with dyspnea for cardiac workup, as well as a low threshold for referring HFpEF patients for sleep study.

Circulation, Volume 148, Issue Suppl_1, Page A17889-A17889, November 6, 2023. Background:Sleep apnea (SA) represents a risk for arrhythmia recurrence following catheter ablation (CA) of atrial fibrillation (AF). Continuous positive airway pressure therapy (CPAP) is the established standard treatment for moderate to severe SA. While CPAP exhibits promise in reducing AF recurrences post-CA, the evidence is not entirely consistent. The impact of CPAP for severe SA on very late recurrence post-CA of AF has not been elucidated.Methods:This study employed a retrospective, single-center, observational design. Data were derived from SA screening tests routinely performed in patients scheduled for CA of AF in our facility. We defined severe SA as an apnea-hypopnea index (AHI)≥30 by a home sleep apnea test or polysomnography. After excluding patients already diagnosed with sleep apnea before CA, we enrolled 461 consecutive severe SA patients. We divided them into two groups according to whether they had more than 1-year usage of continuous positive airway pressure after CA (CPAP group) or not (non-CPAP group). CPAP usage was monitored through telemonitoring and regular follow-up visits at our outpatient clinic every three months. Very late AF recurrence was defined as AF recurrence more than 1-year after the index CA.Results:The age was 65±10 years, 17.6% were females, and 60.1% had non-paroxysmal AF. The mean AHI was 37.4±15.3. The CPAP group included 32.8% (n=151) and non-CPAP group 67.2% (n=310). The AF recurrence rates within 1-year post-CA were similar between the two groups (CPAP group vs. non-CPAP group, 17.2% vs. 15.8%, log-rank p=0.88). However, the very late AF recurrence rate was lower in the CPAP group than non-CPAP group (CPAP group vs. non-CPAP group, 5.6% vs. 15.4%, log-rank p=0.0089).Conclusion:Among the untreated severe sleep apnea patients at the time of the catheter ablation of AF, CPAP treatment during 1-year post-CA was associated with fewer AF recurrences beyond 1-year post-CA.

Circulation, Volume 148, Issue Suppl_1, Page A18428-A18428, November 6, 2023. Introduction:Obstructive sleep apnea (OSA) is known to cause left atrial (LA) remodeling. The effect of continuous positive airway pressure (CPAP) on LA remodeling in patients with OSA and paroxysmal atrial fibrillation (AF) has not been assessed.Hypothesis:We aimed to assess the impact of CPAP treatment on reverse LA deformation and volume in patients with AF and OSA.Methods:In this secondary analysis of a prospective randomized controlled trial, we screened patients with AF for OSA. The majority of patients were referred for pulmonary vein isolation (PVI). We included AF patients with OSA defined as apnea-hypopnea index (AHI) > 15/h. Patients were randomized to CPAP treatment or standard care. Transthoracic echocardiography was performed to assess atrial remodeling by two-dimensional speckle tracking LA reservoir strain (by AFI LA) and LA volume index (LAVI) in apical 2- and 4-chamber views in sinus rhythm at baseline and at 12 months’ follow-up by an investigator blinded to allocated arm. AF burden was monitored by an implantable loop recorder in all patients.Results:We included 104 patients (62 ±7 years old, 77% men, BMI 30 ± 4) of whom 50 were randomized to CPAP and 54 to standard care. PVI was performed in 83 patients six months after the baseline exam. There was no clear improvement in LA reservoir strain in either group from baseline to follow up (CPAP: 30 ± 8 % vs 32 ± 9 %, p = 0.15; standard care: 28 ± 7 % vs 30 ± 6 %, p = 0.11), and there was no difference between the groups (p=0.41). Similarly, LAVI did not change in the CPAP group (38±8 mL/m2vs 36± 10ml/m2, p= 0.16) or in the standard care group (39± 10 mL/m2vs 37 ± 12 ml/m2, p= 0.20) during follow-up, with no difference between the two groups (p =0.62). In patients who underwent PVI, the AF burden decreased in both treatment arms, with no between-group difference (p = 0.69).Conclusions:In AF patients with OSA, treatment with CPAP did not improve reverse left atrial remodeling within 12 months. Although the trial was relatively small, these results suggest that CPAP is unlikely to have a major impact on normalization of LA function after atrial fibrillation ablation in this patient group.

Circulation, Volume 148, Issue Suppl_1, Page A17346-A17346, November 6, 2023. Background:Atrial fibrillation (AF) causes significant morbidity and mortality. Obstructive sleep apnea (OSA) has been suggested as a risk factor for AF, but the causal relationship between the two is still being investigated. We performed a systematic review and meta-analysis of Mendelian Randomization (MR) studies to determine OSA’s role in AF.Methods:We searched PubMed, Scopus, Embase, and Google Scholar databases for MR studies on the causal relationship between OSA and AF through June 2023. Our analysis included eligible studies. The pooled odds ratio and subgroup analysis were calculated using the random-effects model. The I2 statistic was used to assess study heterogeneity, and a leave-one-out sensitivity analysis was performed to determine how individual studies affected the overall estimate and analysis robustness.Results:5 MR studies met our inclusion criteria until June 2023. In these studies, one used diverse datasets and included patient data of 5 cohorts with UK, Canada, Australia, USA, Finland ancestry while the remaining 4 included patient data of European ancestry. Genetic predisposition to OSA was found to cause AF in the pooled odds ratio analysis (OR 1.21, 95% CI 1.15-1.28, I2=0.00%, p

Circulation, Volume 148, Issue Suppl_1, Page A17982-A17982, November 6, 2023. Background:Obstructive sleep apnea (OSA) has been associated with many forms of heart rhythm disorders, including bradycardia and cardiac conduction delay. Here, we aimed to investigate the relationship between OSA and bradyarrhythmias.Methods:A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 to 2020. 1,685,704 hospitalizations with a primary diagnosis of bradyarrhythmias (including sinus node dysfunction, atrioventricular block and cardiac conduction disorder with 1:1 AV conduction) were identified and stratified based on the presence of OSA using ICD-10 codes. Multivariate regression analysis was used to adjust for confounders and analyze the variables.Results:Out of the 1,685,704 hospitalizations with bradyarrhythmias, 204,307 (%12.1) had OSA. In-hospital mortality in patients with OSA was significantly lower (3.51% vs 5.64%; p

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