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

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.

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

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.

Potenziale cura per cardiomiopatia amiloide da transtiretina

Circulation, Volume 146, Issue Suppl_1, Page A15887-A15887, November 8, 2022. Introduction:Previous studies have demonstrated that obstructive sleep apnea (OSA) and obesity independently increase the risk for development of atrial fibrillation (AF). However, it is unknown whether weight changes in an OSA cohort also increase the risk of AF.Methods:This was a case control study from a single tertiary institution analyzing patients with a confirmed OSA diagnosis from 2013-2020. Patients with missing data on any of the key variables were excluded from these analyses. The covariates included smoking history, hypertension, congestive heart failure, chronic obstructive pulmonary disease, heart failure, and coronary artery disease. Patients’ weight at the time of AF diagnosis by electrocardiogram (ECG) was compared to the weight documented one year earlier. Weight at the time of the ECG closest to the sleep study date was compared to the weight one year prior for the control group. ​​Multivariate logistic regression analysis to examine the association between AF cases (versus controls) and weight percent change greater than 5%.Results:Among the 182 patients included in the analysis, the incidence of AF was 32.4% and the median weight change was -1.32± 11.69 lb (Table 1). About 36% of those diagnosed with AF had weight changes (gain or loss) above 5% compared to 23% in the control group (p = 0.07). The average weight change for those with diagnosed AF compared to individuals without AF was -2.5 ±11.8 lb vs. -0.76 ± 11.6 lb (p=0.19). The change in the adjusted odds of AF diagnosis among those with more than 5% weight gain or loss was 2.27 (95% CI =1.01, 5.09) compared to those with less or no weight change.Conclusions:Among individuals with OSA, those who exhibited weight changes greater than 5% over a one year period have increased odds for developing AF. Further large-scale studies need to be undertaken to understand the link between intentional versus unintentional weight loss.

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 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 A15100-A15100, November 8, 2022. Introduction:Obstructive sleep apnea (OSA) is a common and underestimated chronic condition recognized as a risk factor for cardiovascular diseases. OSA and acute coronary syndrome (ACS) have been reported in several cases. This study aims to assess the prevalence of the OSA among patients with ACS.Hypothesis:We hypothesize that there is a correlation between OSA and ACS.Methods:This study is a cross-sectional, descriptive study that included 110 patients with ACS at the Cairo University Hospitals in Egypt between December 2018 and July 2019. We included patients diagnosed with ACS over the age of 40. We excluded patients who had disturbed consciousness levels, were intubated/mechanically ventilated, were on psychiatric medications, or used drugs. Furthermore, we excluded individuals with CKD or liver disease. We collected patients’ demographic characteristics, and chronic medical conditions, and performed a sleep assessment. Every patient had a detailed workup for ACS. We assessed OSA based on the STOP-BANG score. The significance of baseline and clinical characteristics, laboratory and imaging findings, and the severity of ACS and its outcome were studied.Results:The mean age of the patients was 58.2±9.6. The majority of patients were male (74.5%). 70.9% of the patients had metabolic syndrome. The mean body mass index was 28.6±4.8; the majority of patients presented with STEMI (60.9%), while only 26.4% and 12.7% presented with NSTEMI and unstable angina respectively. The prevalence of OSA among ACS patients was 63.6%, and of them, 55.7% presented with STEMI, while only 32.9% and 11.4% presented with NSTEMI and unstable angina respectively. Also, the study revealed a statistically significant relationship between OSA and NSTEMI patients (OR: 2.77 [95% CI 1.02-7.55], p=0.041), while there was no statistically significant relationship between OSA and unstable angina patients (OR: 0.73 [95% CI 0.2-2.3], p=0.579) and between OSA and STEMI patients (OR: 0.54 [95% CI 0.2-1.2], p=0.14).Conclusion:To the best of our knowledge, this is the first study to study the prevalence of OSA in ACS patients in the region of Africa. The study indicated a high prevalence of OSA among ACS patients, with a more significant correlation between OSA and NSTEMI patients.

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

Circulation, Volume 146, Issue Suppl_1, Page A10345-A10345, November 8, 2022. Introduction:The prevalence of obstructive sleep apnea (OSA) in heart failure (HF) patients varies from 30 to 50%. The differences in clinical characteristics, healthcare resource utilization (HCRU), and positive airway pressure (PAP) usage between HF with preserved ejection fraction (HFpEF) vs. HF with reduced ejection fraction (HFrEF) in OSA patients are not well known.Objective:To compare clinical characteristics, PAP usage, and HCRU in OSA patients with HFpEF vs HFrEF.Methods:Retrospective cohort study using US administrative claims data linked to objective PAP usage data over one year. HFpEF and HFrEF were identified by ICD-9/10 codes associated with healthcare encounters 1 year before starting PAP therapy. Pearson’s Chi-squared and Wilcoxon rank-sum tests were used as applicable to compare baseline characteristics and PAP usage, and the pre to post-PAP initiation difference in the number of health care encounters.Results:In total, 7,419 patients with HF and OSA were identified, of which 57% had HFpEF. HFpEF patients were majority female (54%) and older than those with HFrEF (64.1 ± 11.52 vs 59.7 ± 11.24 years, 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 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 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 A11760-A11760, November 8, 2022. Background:​​Depression is a frequently encountered comorbidity in patients with Obstructive Sleep Apnea (OSA), with a higher prevalence than the general population. However, there is limited data on the impact of psychiatric comorbidities on the outcomes of OSA.Methods:We identified OSA hospitalizations using the National Inpatient Sample (2018) and relevant ICD-10 codes. After propensity score matching, demographics and comorbidities were compared between the two groups of OSA with (OSA-D+) vs without depression (OSA-D-). The odds of in-hospital outcomes between them were analysed using multivariable regression analyses.Results:Of the 2169730 OSA hospitalizations, 20.1% had comorbid depression. Matched cohorts included 846150 admissions in both groups – OSA-D+ and OSA-D-.The OSA-D+ cohort often consisted of younger (median age, 64 vs 65); females (55.5% vs 55.2%) with both cohorts predominantly including white, Medicare enrollees. The OSA-D+ cohort had significantly higher rates (all p

Circulation, Volume 146, Issue Suppl_1, Page A11028-A11028, November 8, 2022. Introduction:Heart failure patients with preserved ejection fraction (HFpEF) frequently have co-morbid obstructive sleep apnea (OSA), although the impact of OSA treatment remains unclear in this patient population. We assessed the association between adherence to positive airway pressure (PAP) therapy and healthcare resource utilization in patients with OSA and HFpEF.Methods:Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFpEF were used to measure the association of PAP adherence and healthcare resource utilization, defined by hospitalizations and emergency room (ER) visits. US Medicare defines PAP compliance as use for at least 4 hours/night for 70% of nights in a consecutive 30-day period over 90 days. PAP adherent patients met this criteria for all 4 90-day periods, while PAP non-adherent patients did not meet this criteria for any 90-day period over one year. Propensity score methods were used to create well matched groups with differing PAP adherence levels.Results:The study cohort consisted of 4,237 eligible patients (54.0% female, mean age 64.1 years), of whom 40% were considered adherent to PAP therapy (30% intermediate-adherent, 30% non-adherent). After propensity score matching on prior year covariates, during the year after PAP prescription, PAP adherent patients had fewer hospital visits than non-adherent patients, with a 57% reduction in hospitalizations and a 36% reduction in ER visits for PAP adherent patients (Table 1a). These results remained consistent with inverse probability weighting, and furthermore showed a significant difference in hospitalizations between intermediate-adherent and non-adherent patients, but no significant difference in ER visits (Table 1b).Conclusions:Treating OSA with PAP therapy in patients with HFpEF is associated with a reduction in hospitalizations and ER visits. Adherence to PAP therapy is required to realize these clinical benefits.