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

Stroke, Volume 55, Issue Suppl_1, Page ATP251-ATP251, February 1, 2024. Objective:Evidence has shown that obstructive sleep apnea (OSA) is associated with the development of stroke. However, there is limited data on how OSA can influence the development and severity of post stroke complications. This study was done to investigate the potential relationship between OSA and post stroke complications and systematically review the current literature available on the topic.Methods:PubMed, Web of Science and Scopus Databases were used to collect data from the published literature up to December 2022. The studies that met the inclusion criteria were selected and Review Manager 5.4.1 was used for statistical analysis of data. Pooling of data with heterogeneity was done using a random-effects model. The findings were presented by using the standard mean differences within their 95% confidence intervals.Results:The analysis showed that stroke patients experiencing OSA do not significantly have higher post-stroke complications (i.e mild cognitive impairment, dementia, insomnia, fatigue, sleep quality, post-stroke depression, anxiety, recurrent strokes) compared to those stroke patients who do not have OSA (RR=1.05, 95% CI 0.97 to 1.13). Similarly, stroke patients experiencing OSA did not have any statistically significant risk of depression (RR=0.92, 95% CI = 0.58 to 1.48) or cognitive impairment (RR=1.05, 95% CI –0.90 to 1.23). Among patients with high stroke severity, those who have OSA have higher risk of post-stroke complications than those patients without OSA (RR=1.06, 95% CI –1.01 to 1.12)Conclusion:This systematic review and meta-analysis attempted to consolidate the literature and potentially suggested a possible positive relationship between OSA and post-stroke complications mainly with neuropsychiatric comorbidities including cognitive impairment, depression and anxiety. Further studies are required to explore the impact of OSA on post stroke complications.

Il trattamento a Philadelphia, è la prima persona ad ottenerla

Sono 224mila i casi diagnosticati, ma si stimano circa 600mila

Ok Aifa a rimborsabilità farmaco che agisce a livello cerebrale

Sono 224mila i casi diagnosticati, ma si stimano circa 600mila

A Miami insignito del riconoscimento internazionale Phacilitate

In un mese 1,1 milioni di casi, ma forse 19 volte di più

Per le forme con mutazione dei geni Brca. Cala del 42% il rischio recidiva

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 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 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