Search Results for: Prima terapia farmacologica per l’apnea notturna (OSAS)

Mouth taping is a sleep technique that has been promoted widely across social media. Although mouth breathing during sleep is associated with severity of obstructive sleep apnea (OSA), research recently published in JAMA Otolaryngology–Head & Neck Surgery suggests that it may be important to maintain airflow in some patients with nasal obstruction.

I moderni dispositivi permettono di adattare la terapia insulinica alle esigenze individuali di ciascun paziente, migliorando l’efficacia del trattamento

Circulation, Volume 150, Issue Suppl_1, Page A4140180-A4140180, November 12, 2024. Introduction:Sleep apnea is a common sleep disorder that can worsen atrial fibrillation(AF) prognosis. Benzodiazepines(BZD) are commonly prescribed for insomnia, which often accompanies sleep apnea. However, BZDs have been associated with worsening of sleep apnea due to respiratory depression, pharyngeal muscle relaxation, and increase of arousal threshold, which all may lead to prolonged hypoxia. There is little research on the effect of BZD use in AF patients with sleep apnea. Therefore, the objective of this study is to investigate the effects of BZD usage on outcomes in the AF population with sleep apnea.Methods:Data from patients with AF and sleep apnea seen at Tulane Medical Center between 2010 and 2019 was obtained from Research Action for Health Network(REACHnet), a Clinical Research Network in PCORnet®. Patients with AF and sleep apnea were divided between those with a prescription of BZD and those without BZD. These two groups were compared using the Kaplan-Meier method for time-to outcome for all-cause mortality, ischemic stroke, myocardial infarction(MI), and hospitalizations in the five years following their AF diagnosis. Cox regression analysis was used to investigate proportional hazards and control for demographics, comorbidities, and medication use.Results:There were 524 total patients included with AF and sleep apnea. Of these, 413(78.8%) were not prescribed BZDs, while 111(21.1%) were taking BZDs. Use of BZDs was associated with worse outcomes. In the no BZD and the BZD group over the 5 years following AF diagnosis, the rate of mortality was 6.1% and 12.6%(p

Circulation, Volume 150, Issue Suppl_1, Page A4136963-A4136963, November 12, 2024. Background:There is increasing evidence of a strong association between obstructive sleep apnea (OSA) and ischemic heart disease. Previous studies have demonstrated OSA to be a significant predictor of incident CAD, while recent studies have confirmed individuals with OSA to have 3.9 times greater incidence of major adverse cardiac and cerebrovascular events (MACCE) at one year following acute myocardial infarction (AMI) than individuals without OSA. Whether treatment with continuous positive airway pressure (CPAP) after AMI in OSA patients reduces MACCE is not known. This study investigated the long-term cardiovascular outcomes associated with CPAP therapy after AMI in OSA patients, and is the first study to evaluate the effect of CPAP on secondary prevention after AMI.Methods:This retrospective study was conducted from 2015 to 2019 and included adults with AMI. Patients with at least moderate OSA (n=180) were followed for at least 1 year and categorized as either AMI and compliant to CPAP (54 patients) or AMI and non-compliant to CPAP (126 patients). We estimated the incidence of MACCE (early rehospitalization, re-catheterization, CABG, recurrent MI, CHF, arrhythmia, stroke, and death) in each group during follow-up from the index event. Continuous and categorical variables were analyzed for significance with Wilcoxon’s test and Fisher’s exact test respectively. Multivariate analyses were performed to adjust for confounders.Results:Most participants were male, the average age was 66 years old, and no significant demographic difference was identified between the two groups. Compared with non-compliant patients, CPAP-compliant patients exhibited significantly lower overall MACCE incidence (22.2% vs 40.5%, p=0.03) and repeat catheterization rate (1.9% vs 11.1%, p=0.04) after AMI.Conclusion:Long-term, compliant CPAP therapy, as compared with non-compliant CPAP therapy, significantly reduces recurrent cardiovascular events and provides effective secondary prevention after AMI in patients with at least moderate OSA.

Circulation, Volume 150, Issue Suppl_1, Page A4144517-A4144517, November 12, 2024. Introduction:General anesthesia is commonly utilized during catheter ablation of atrial fibrillation (AF) in the United States, providing patient immobility and permitting esophageal temperature management for radiofrequency ablation. Pulsed field ablation (PFA) is associated with shorter procedure time, less risk of esophageal injury, and less dependence on catheter stability compared with radiofrequency ablation. There are limited data available on performing the procedure with deep sedation as an alternative to general anesthesia with endotracheal intubation.Methods:Consecutive patients who underwent catheter ablation of AF at Endeavor Health (Chicago, IL) using pulsed field ablation (Farapulse, Boston Scientific, Marlborough, MA or PulseSelect, Medtronic, Minneapolis, MN) and deep sedation between March and May 2024 were retrospectively included in this study. Deep sedation (monitored anesthesia care) was administered by a certified registered nurse anesthetist and attending anesthesiologist, consisting of bolus and infusion dosing of propofol, dexmedetomidine, fentanyl, and midazolam at the discretion of the practitioner with continuous monitoring of vital signs and end-tidal CO2. The primary endpoint was the rate of airway complications or requirement for conversion to general anesthesia. Secondary endpoints were the rate of acute procedural success (all pulmonary veins isolated), total time in the EP lab, procedure time (from lidocaine to removal of sheaths), and non-procedure time (difference between total time in lab and procedure time).Results:A total of 40 patients (mean age 70.4 ± 13.6 years, BMI 30.2 ± 7.4, 60% females) were included in the analysis. There were no instances of airway complications or conversion from deep sedation to general anesthesia. There was a 100% rate of acute isolation of pulmonary veins. The average total time in the lab was 156.6 ± 41.5 minutes; consisting of a mean procedure time of 107.1 ± 39.7 minutes and non-procedure time 49.5 ± 10.3 minutes.Conclusions:In this initial experience at a single center, deep sedation (monitored anesthesia care) for PFA was associated with no instances of airway complications. The findings may not apply to patients with moderate or severe obstructive sleep apnea or other pulmonary diseases. Although patients generally were amnestic to the procedure, larger studies incorporating patient-reported outcomes are needed, as well as data regarding long-term clinical outcomes and cost.

Circulation, Volume 150, Issue Suppl_1, Page A4136996-A4136996, November 12, 2024. Introduction:Insomnia and obstructive sleep apnea (OSA) each increase risk for hypertension (HTN). Among older adults, there is a negative synergistic association of comorbid insomnia and OSA (i.e., COMISA) on incident cardiovascular disease (CVD) but it is unknown if this comorbidity is associated with HTN risk earlier in the lifespan.Research Questions:1) Is COMISA associated with incident HTN among younger adults? 2) Do COMISA-HTN associations differ by sex?Hypotheses:We hypothesized that 1) COMISA would be associated with a greater risk of HTN than having no sleep disorder, 2) the hazard would be larger than for insomnia and OSA alone, and 3) distinct COMISA-HTN associations would be observed among men and women, respectively.Methods:Analyses included Veterans who enrolled in Veterans Health Administration (VA) care 2001-2021, a group selected because of its early adult age distribution. We merged administrative data, including outpatient and inpatient encounters, diagnoses, (ICD-9-CM/10 codes/dates) and pharmacy records. Veterans without demographic data, a history of other sleep disorders or CVD, or

Circulation, Volume 150, Issue Suppl_1, Page A4142037-A4142037, November 12, 2024. Introduction:Ischemia and nonobstructive coronary arteries (INOCA) is increasingly recognized and encompasses vasomotor disorders such as coronary microvascular dysfunction (CMD) and vasospastic angina (VA). The prevalence of atherosclerotic coronary artery disease increases with age, but the age at the time of diagnosis in patients with INOCA is not well described.Methods:From 2017 to 2024, 221 patients with INOCA underwent invasive coronary physiologic assessment including vasoreactivity testing with acetylcholine provocation, guidewire-based assessment of coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and fractional flow reserve (FFR). Age cut-off of 60 years was selected to create two groups of adequate size.Results:Mean age was 57.7 ± 10.8 years and 158 (71.5%) were females. Older INOCA patients ( >60 years old) had higher rates of hypertension and obstructive sleep apnea, but similar rates of hyperlipidemia, diabetes, depression, anxiety, and active smoking compared to younger patients (

Circulation, Volume 150, Issue Suppl_1, Page A4145962-A4145962, November 12, 2024. Introduction:Obstructive sleep apnea (OSA) affects nearly a billion adults worldwide, and is associated with an increased risk of coronary artery disease, heart attack, heart failure, and arrhythmias – notably atrial fibrillation (AF). Low cost, point of care mobile electrocardiograms (MobileECGs) record and detect heart rhythm abnormalities in 30 seconds. This study aims to assess the effectiveness of the KardiaMobile (AliveCor) MobileECG device as an AF screen in the OSA patient population.Methods:The MobileECG Sleep Study enrolled 500 adult University of Florida Health patients in an observational study between March 2021 and March 2024. After providing consent and completing a brief survey regarding pre-existing health conditions and overall sleep health, a trained research assistant performed the AF screening with the KardiaMobile ECG device. ECG readings were marked for previously undetected abnormalities (potential AF, tachycardia, bradycardia, etc.) and statistically analyzed to determine stroke risk using the CHA2DS2-VASc scoring system. CHA2DS2-VASc criteria includes congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female).Results:A total of 500 participants were enrolled over a 3 year period at University of Florida Health Sleep Center. Of which 276 (55.2%) were female and 224 (44.8%) were male, with a mean age of 56.34 (SD 15.74) and a mean weight of 222.50 (SD 63.25). Of those tested, 68 (13.6%) had irregular, previously undetected AF readings. Patients with irregular AF readings using the KardiaMobile ECG device had CHA2DS2-VASc scores of t(68) = 2.15, p = .042, d = 0.26 indicating an intermediate risk for stroke. Oral anticoagulation is recommended for a score of ≥ 2 if the patient has no contraindication. After prior 12-lead ECG data for patients is obtained the determinations will be compared to the KardiaMobile ECG readings using Cohen’s Kappa.Conclusion:MobileECGs offer a rapid, point of care screening tool for AF in an outpatient sleep clinic setting. Early detection of AF in the OSA patient population can result in improved outcomes and reduced instances of stroke events through anticoagulation therapy guided by CHA2DS2-VASc scores. Further research is necessary to understand the long term impact of surveillance AF screening in high risk patient populations on mortality and cost of healthcare.

Circulation, Volume 150, Issue Suppl_1, Page A4141061-A4141061, November 12, 2024. Background:Expansion of thorax and abdomen during normal respiration generates negative intrathoracic pressure that affects organs like the heart and esophagus. Upper airway collapse during sleep increases respiratory effort. Measuring esophageal pressure (PES) is the gold standard for estimating this effort.Heart failure is highly associated with obstructive sleep apnea (OSA). Abrupt swing in thoracic pressure and nocturnal hypoxemia during apnea are two mechanisms that can lead to heart failure.Hypothesis:PES and traditional sleep metrics: apnea hypopnea index (AHI), oxygen desaturation index (ODI), and mean-spO2 are associated with increased mortality risk in patients with heart failure and OSA.Methods:174 patients with heart failure identified in the local heart failure registry in Akershus university hospital. All patients underwent respiratory polygraphy and esophageal manometry during sleep. Observation time 2003-2024.AHI, ODI, mean-spO2 and sleeping time with elevated esophageal pressure above different cmH2O, PES, were measured. Initial proBNP were also analyzed. Cox proportional hazard models were used to analyze the risk. Results were adjusted to age, sex, body mass index (BMI), and comorbidities.Results:Mean age 66 years (SD 12.019). 34 (20%) of observed cases were females. 70 (40%) patients died during observation time. Mean time to event (death) from first proBNP 3,5 years. Mean time to event from baseline polygraphy 8,2 years.First proBNP predicted all-cause mortality (HR 1.108 [95% CI 1.052-1.167], p15, ODI and mean-spO2 during sleep predicted all-cause mortality, but not sleep time with elevated esophageal pressure above 15 cmH2O. Sleep time with higher pressure degrees (above 80 cm H2O) did predict mortality.Adding first proBNP to our prediction model did not affect the predictive value of mean-spO2 (HR 0.828 [95% CI 0.752 -0.912], p

Circulation, Volume 150, Issue Suppl_1, Page A4147561-A4147561, November 12, 2024. Introduction:Recent evidence from the literature has shown that obstructive sleep apnea (OSA) may contribute to worsening outcomes of patients with heart failure. However, most OSA studies were conducted in the HFrEF population. There remains scarce data on the impact of OSA in HFpEF hence, we aimed to study this population.Methods:We conducted a retrospective analysis of the 2020 National Inpatient Sample (NIS) database. Using the ICD-10 codes, we identified the codes for HFpEF and OSA. We adjusted for cofounders and used multivariate logistic regression model to analyze the odds ratio (adjusted odds ratio (aOR)) of our outcomes of interest.Result:There were 2,115,015 hospitalizations for HFpEF, and 18.1% (383,624) had a diagnosis of obstructive sleep apnea. The mean age was 69.5 years, with males having a prevalence of 51%. Of these, 74% were Caucasians, 17.26% were Blacks, and 5.24% were Hispanics. Following multivariate analysis, we found that HFpEF patients with OSA had significant odds of atrial fibrillation, adjusted odds ratio (aOR) 1.28(1.26 -1.31 p=0.000), coronary artery disease 1.23(1.20-1.26 p=0.000), obesity 3.49(3.41-3.57 p=0.000), diabetes mellitus 1.11(1.08-1.14 p=0.000), second-degree heart block 1.2(1.09-1.34 p=0.000), bifascicular heart block 1.08(1.02-1.14 p=0.003), defibrillator use 1.36 (1.04-1.77 p=0.026). However, OSA was not significantly associated with atrial flutter 1.03(0.99-1.06 p=0.13), third-degree heart block 1.07(0.99-1.15 p=0.072), ventricular tachycardia 1.01(0.95-1.07 p= 0.762).Conclusion:This analysis showed that HFpEF patients with OSA had higher likelihood of arrhythmias, and ischemic cardiac events. Lifestyle modifications including weight loss, healthy diet, and appropriate CPAP use should be encouraged in these patients.

Circulation, Volume 150, Issue Suppl_1, Page A4145118-A4145118, November 12, 2024. Background:Obstructive Sleep Apnea (OSA) is the most common sleep related disorder and shares common pathophysiological mechanisms with Peripheral Arterial Disease (PAD). Studies exploring the influence of OSA on PAD have largely focused on subclinical markers of PAD such as ankle brachial indices and pulse wave velocities. We sought to investigate the association of OSA with Major Adverse Limb Events (MALE) in patients with PAD.Methods:National Inpatient Sample 2018-2020 was utilized for this analysis. MALE was the primary outcome, defined as a composite of Acute Limb Ischemia, Limb Revascularization (either percutaneous or surgical), limb amputation and All-Cause mortality. ICD-10 codes were utilized to identify the diagnoses of choice. Propensity score matching was performed between the 2 groups of OSA and no OSA using the caliper match method for the variables, Age, Gender, Stroke, Obesity, Hypertension, Anemia, Coagulopathy, ESRD, Diabetes, Chronic Pulmonary Disease, Congestive Heart Failure, Cardiac Arrythmias and Valvular Heart Disease. Weighted samples were utilized and p

Circulation, Volume 150, Issue Suppl_1, Page A4146790-A4146790, November 12, 2024. Introduction:Available data suggest there is some regularity in the time of the day when patients experience their first clinical symptoms (pain) of ST Elevation Myocardial Infarction (STEMI). It has been noticed that the largest number of cases of myocardial infarction are observed in the early morning. Some studies, especially in Asian populations, have found a shift into the afternoon hours. Additionally, some publications suggest the existence of secondary peaks of incidence in the evening hours. There also seems to be a relationship between night hours and the occurrence of myocardial infarctions in patients with sleep apnea. Although the risk of myocardial infarction is highest in the morning, there are differences depending on the region and population which might indicate the influence of local and individual factors on the circadian rhythm of the disease.Objective:To analyze circadian variation of STEMI first chest pain onset occurence on one of the largest populations tested so far and to see if there is an association with time delays to Percutaneous Coronary Intervention (PCI).Methods:Data from the Polish National PCI Registry (ORPKI Registry) on patients with confirmed STEMI diagnosis who underwent either coronary angiography and/or PCI from 2014 untill 2022 were analyzed.Results:There were 153 543 individual patients in the analyzed time period with 68% of males. Circadian variation in the probablity of STEMI occurence in both men and women is presented in Figure 1 (p >0.05). Median time from chest pain onset to first medical contact (FMC) was 180 minutes (60-260; 95% CI) at 3 am and 90 minutes (59-196; 95% CI) at 1 pm respectively (p