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

Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici

Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici

Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici

This 2022 Recommendation Statement from the US Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in the general adult population (I statement).

This systematic review to support the 2022 US Preventive Services Task Force Recommendation Statement on screening for obstructive sleep apnea (OSA) in adults summarizes published evidence on the benefits and harms of screening for OSA in asymptomatic adults and use of positive airway pressure and mandibular advancement devices for treatment of OSA.

This JAMA Patient Page summarizes the US Preventive Services Task Force’s recommendations on screening for, and treatment of, obstructive sleep apnea in adults.

An association of extreme obesity with hypersomnolence was recognized in antiquity and described in the early 19th century in both medical texts and, most famously, in Dickens’ Posthumous Papers of the Pickwick Club. However, not until the first polysomnographic recordings of sleep and respiration were made in the 1960s was it recognized that apneas resulting from intermittent obstruction of the upper airway during sleep, causing hypoxemia and cortical arousal, contributed to the excessive sleepiness in these so-called “Pickwickian” patients. The term “obstructive sleep apnea syndrome” was coined the following decade, and it was soon recognized that intermittent partial airway obstruction during sleep, resulting in reduced airflow (hypopnea) without apnea, could result in an identical clinical syndrome.

Potenziale cura per cardiomiopatia amiloide da transtiretina

Circulation, Volume 146, Issue Suppl_1, Page A12085-A12085, November 8, 2022. Introduction:In patients with heart failure with reduced ejection fraction (HFrEF), sleep-disordered breathing (SDB) may affect, or be affected by cardiac structure and function. We hypothesized that patients with OSA would demonstrate left ventricular (LV) remodeling and impaired LV function intermediate between that of patients with CSA and patients with no SDB.Methods:ADVENT-HF is a multinational randomized trial investigating the effect of adaptive servo ventilation in patients with HFrEF and SDB. Inclusion required LV ejection fraction (LVEF) ≤45%, and a polysomnographic (PSG) apnea-hypopnea index (AHI) ≥15. Subjects with an AHI

Circulation, Volume 146, Issue Suppl_1, Page A11616-A11616, November 8, 2022. Introduction:Obstructive sleep apnea (OSA), a highly prevalent disorder, triples cardiovascular risk. Our previous studies showed that intermittent hypoxia (IH), the hallmark of OSA, triggers endothelial cell (EC) inflammation by reducing protection against complement activity, which is cholesterol-dependent. We assessed whether IH promotes accumulation of cellular cholesterol in ECs in OSA patients and investigated the underlying mechanisms.Methods:We used ECs collected from OSA patients and cultured human umbilical vein ECs (HUVECs) exposed to IH (alternating 30 min 21% O2for normoxia/30 min 2% O2for hypoxia for 8 h).Results:Levels of free, cellular cholesterol were increased and the presence of lipid droplets was reduced in ECs from OSA patients compared with OSA-free controls as well as in HUVECs exposed to IH compared with normoxia. Cholesterol uptake and synthesis were similar in normoxia and IH. In contrast, co-localization of free cholesterol and late endosome/lysosome (LE/LY) was increased in IH compared with normoxia, suggesting impaired trafficking of free cholesterol from LE/LY to endoplasmic reticulum (ER) in IH. Immunoglobulin binding protein (BiP), a marker of ER stress, was upregulated in ECs of OSA patients compared with controls. IH-induced ER stress reduced interaction between LE/LY-bound oxysterol binding protein-related protein-1L (ORP1L) and ER-bound VAMP-associated protein-B (VAPB), which is required for cholesterol trafficking from LE/LY to ER. After screening ER-associated degradation machinery components for potential binding to VAPB in IH, we identified Derlin1 as a ligand that binds increasingly to VAPB in IH thereby potentially reducing interaction between ORP1L and VAPB. In OSA patients, ORP1L-VAPB interaction was reduced whereas Derlin1-VAPB was increased and positive airway pressure, a standard therapy for OSA, reversed these changes.Conclusions:IH induces ER stress that disrupts cholesterol trafficking from LE/LY to ER leading to accumulation of free cholesterol in ECs, which underlies impaired endothelial protection against complement and endothelial inflammation that may increase cardiovascular risk in OSA.

Circulation, Volume 146, Issue Suppl_1, Page A9458-A9458, November 8, 2022. Introduction:This study aimed to investigate the interaction between obstructive sleep apnea (OSA) and development of atrial fibrillation (AF) by analyzing P-wave terminal force in V1 (PTFV1), an ECG parameter related to left atrial (LA) abnormalities. ECG-defined LA abnormalities, indicative of some structural or electrical remodeling, is suggestive of a predisposition to AF.Hypothesis:In patients with OSA, the odds of having an ECG with an abnormal PTFV1 value (as defined by > -4000 μV*ms) are higher in those who developed AF, compared with controls.Methods:A retrospective review was conducted in patients who underwent a polysomnography (PSG). Inclusion criteria for data collection were completion of PSG, diagnosis of OSA, and record of ECG. Manual measurements which were done using the EP Calipers software (EP Studios, Inc.) to standardize our approach.Results:62 patients with AF and 377 control patients without AF were included for analysis. Baseline characteristics were similar between the two subgroups (relevant parameters are tabulated in table 1). PTFV1 was significantly higher in the AF subgroup (-4593.01 μV*ms) vs the control subgroup of -1906.2 μV*ms (p [-4,000 μV*ms]. The odds ratio was calculated to be 3.32 (CI 1.89-5.84).Conclusions:We found that in a cohort of patients with OSA, the odds of having an ECG with an abnormal PTFV1 value (as defined by > -4000 μV*ms) were higher in those who developed AF, compared with those who did not. This value is comparable to previous odds ratios calculated in the general population, but appears elevated in our cohort, suggesting a heightened risk in individuals with OSA irrespective of OSA severity (as noted by AHI), arousal index, or CPAP usage. Future research should expand on these preliminary results to include a larger sample size and more robust patient demographic data.

Circulation, Volume 146, Issue Suppl_1, Page A11728-A11728, November 8, 2022. Background:Secondary pulmonary hypertension (SPH) is a predictor of poor outcomes in obstructive sleep apnea (OSA) patients. In this study, we examined sex/racial disparities, predictors and inpatient mortality in SPH-related hospitalizations among OSA patients.Methods:We used the National Inpatient Sample (2019) and ICD-10 codes to identify OSA-related hospitalizations with SPH. The burden of SPH and disparities by sex/race were assessed. We also compared the odds and predictors of in-hospital mortality in OSA patients with vs. without SPH.Results:Of total adult OSA hospitalizations (n=2317136, median age 66[56-74] years, males: 57.2%), 9.4% (218795/2317136) had SPH. Females vs Males (11.3% vs. 8.1%) and Blacks vs. other race groups (13.5%) with OSA had a higher prevalence of SPH[Fig. 1].The SPH cohort often consisted of females (51 vs 41.9%), blacks (20.9 vs 14.0%), patients from lowest income quartile (29.7 vs 27.6%), Medicare insured (73.4 vs 60.6%), and non-elective admissions (89.2 vs 74.4%) vs. non-SPH cohort. SPH cohort also had a higher burden of complicated HTN (52.9 vs 36.3%), DM with complications (42.7 vs 32.4%), hyperlipidemia (59.4 vs 57.6%), COPD (52.5 vs 36.9%), history of prior MI (11.4 vs 9.6%) and venous thromboembolism (10.4 vs 8.4%). However, in-hospital mortality was more likely to be in males (OR 1.12 95%CI 1.00-1.25, p=0.048) vs Females, and OSA patients with metastatic cancer (OR 2.73 95%CI 2.04-3.65), solid non-metastatic tumors (OR 1.65 95%CI 1.26-2.15) (p

Circulation, Volume 146, Issue Suppl_1, Page A13429-A13429, November 8, 2022. Background:Post-CABG Atrial Fibrillation (PCAF) is linked to higher mortality, morbidity, and healthcare costs. Obstructive Sleep Apnea (OSA) has been studied as a risk factor for PCAF in a few studies. In this study, we sought to review and analyze the association between OSA and PCAF.Methods:We systematically searched PubMed, Scopus, and EMBASE for studies on OSA as predictors of PCAF using relevant keywords through June 2022. Random effects models were used to estimate pooled rates of PCAF with subgroup analysis. I2statistics were used to report inter-study heterogeneity. Leave-one-out meta-analysis was performed to evaluate the effect of each study on the overall estimate.Results:A total of 15 (N= 534387) studies were included between 2008-2021 in our Systematic review/Meta-analysis (Median follow-up duration: 29 days; mean age: 59-72 years; Males: 68.4%). 8 US-based studies, with the rest from Europe and South Asia, were included. A total of 34654 PCAF events were recorded. Pooled analysis of unadjusted (OR 1.23, 95%CI 1.07-1.42, p

Circulation, Volume 146, Issue Suppl_1, Page A14663-A14663, November 8, 2022. Background Sleep apnea (SA) and left atrial dilatation (LA) are both risk factors for an arrhythmia recurrence after catheter ablation (CA) of atrial fibrillation (AF). Negative intrathoracic pressure fluctuations during an obstructive apnea episode may cause the left atrium to distend and stretch its wall. However, the impact of continuous positive airway pressure (CPAP) for SA on the reverse LA remodeling has not been elucidated. Methods This study was conducted under a retrospective, single-center, observational design. Data was derived from screening tests for sleep apnea, which were routinely performed in patients scheduled to receive CA of AF in our institution. The severity of the sleep apnea was evaluated by the apnea-hypopnea index (AHI). After excluding patients who were already diagnosed with sleep apnea, we enrolled 1232 consecutive patients who underwent multidetector computed tomography (MDCT) both before and 3-months after the CA of AF. The left atrial dilatation and volume reduction were evaluated by the left atrial minimum volume (LA min V) using 256-slice MDCT. Results The age was 65±11 years, 27.8% were females, and 46.0% had non-paroxysmal AF. The mean AHI was 20.2±15.2 and LA min V 79.1± 37.8ml (r=0.31, p