Journal of Clinical Medicine

Editorial

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2 pages, 169 KiB

Open AccessEditorial

Biopsychosocial Illness Model: From the Lung to the Eye

by Fabio Scarinci, Mariacristina Parravano and Francesca Romana Patacchioli

J. Clin. Med. 2022, 11(15), 4298; https://doi.org/10.3390/jcm11154298 - 25 Jul 2022

Cited by 1 | Viewed by 746

Abstract

Studies on the impact of different pathologies on the quality of life have made the translation of multidisciplinary scientific knowledge into a unified model of biopsychosocial disease possible in which several important biological variables are integrated with psychological-functional and sociological variables [...] Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

Research

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10 pages, 244 KiB

Open AccessArticle

Obstructing Sleep Apnea in Children with Genetic Disorders—A Special Need for Early Multidisciplinary Diagnosis and Treatment

by Mihaela Oros, Lucica Baranga, Vasilica Plaiasu, Sebastian R. Cozma, Adriana Neagos, Luminita Paduraru, Violeta Necula, Cristian Martu, Lucia Corina Dima-Cozma and Dan Cristian Gheorghe

J. Clin. Med. 2021, 10(10), 2156; https://doi.org/10.3390/jcm10102156 - 17 May 2021

Cited by 7 | Viewed by 2137

Abstract

Background—Children with genetic disorders have multiple anatomical and physiological conditions that predispose them to obstructive sleep apnea syndrome (OSAS). They should have priority access to polysomnography (PSG) before establishing their therapeutic protocol. We analyzed the prevalence and the severity of OSAS in a [...] Read more.

Background—Children with genetic disorders have multiple anatomical and physiological conditions that predispose them to obstructive sleep apnea syndrome (OSAS). They should have priority access to polysomnography (PSG) before establishing their therapeutic protocol. We analyzed the prevalence and the severity of OSAS in a particular group of children with genetic disorders and strengthened their need for a multidisciplinary diagnosis and adapted management. Methods—The retrospective analysis included children with genetic impairments and sleep disturbances that were referred for polysomnography. We collected respiratory parameters from sleep studies: apnea–hypopnea index (AHI), SatO₂ nadir, end-tidal CO₂, and transcutaneous CO₂. Subsequent management included non-invasive ventilation (NIV) or otorhinolaryngological (ENT) surgery of the upper airway. Results—We identified 108 patients with neuromuscular disorders or multiple congenital anomalies. OSAS was present in 87 patients (80.5%), 3 of whom received CPAP, 32 needed another form of NIV during sleep, and 15 patients were referred for ENT surgery. The post-therapeutic follow-up PSG parameters confirmed the success of the treatment. Conclusions—The upper airway obstruction diagnostics and management for children with complex genetic diseases need a multidisciplinary approach. Early detection and treatment of sleep-disordered breathing in children with genetic disorders is a priority for improving their quality of life. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

17 pages, 1711 KiB

Open AccessArticle

The Association of Oxidative Stress in the Uvular Mucosa with Obstructive Sleep Apnea Syndrome: A Clinical Study

by Ewa Olszewska, Joanna Rogalska and Małgorzata M. Brzóska

J. Clin. Med. 2021, 10(5), 1132; https://doi.org/10.3390/jcm10051132 - 08 Mar 2021

Cited by 8 | Viewed by 2903

Abstract

The hypothesis that individuals with obstructive sleep apnea syndrome (OSAS) demonstrate oxidative stress in the uvular mucosa that correlates with OSAS occurrence was investigated. A total of 128 participants (mean age 45.8, mean body mass index 30.7, female–male ratio 1:20) were divided into [...] Read more.

The hypothesis that individuals with obstructive sleep apnea syndrome (OSAS) demonstrate oxidative stress in the uvular mucosa that correlates with OSAS occurrence was investigated. A total of 128 participants (mean age 45.8, mean body mass index 30.7, female–male ratio 1:20) were divided into the non-OSAS group (apnea–hypopnea index—AHI < 5) and OSAS-group (AHI ≥ 5), in which mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30), and severe (AHI ≥ 30) sub-groups were distinguished. Laryngological examination, Epworth Sleep Scale questionnaire, and home sleep study were performed to obtain AHI, mean oxygen saturation, and lowest oxygen saturation. Total oxidative status (TOS) and total antioxidative status (TAS) were assayed in the uvular mucosa taken during palatoplasty or palatopharyngoplasty. The severity of oxidative stress was expressed as oxidative stress index (OSI). Oxidative/reductive imbalance was noted in the mucosa of the uvula of OSAS individuals, and TAS of the uvular mucosa negatively correlated with the severity of this syndrome. TOS and OSI in the mild, moderate, and severe OSAS were higher than in the non-OSAS group, whereas TAS of the uvular mucosa in the OSAS group was lower compared to the non-OSAS group. In conclusion, oxidative stress in the uvular mucosa is associated with the occurrence of OSAS. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

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12 pages, 1044 KiB

Open AccessArticle

Polysomnography and Nocturia Evaluations after Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Syndrome

by Yung-An Tsou, Eric Chieh-Lung Chou, Dung-Yun Shie, Ming-Jeng Lee and Wen-Dien Chang

J. Clin. Med. 2020, 9(10), 3089; https://doi.org/10.3390/jcm9103089 - 25 Sep 2020

Cited by 1 | Viewed by 2131

Abstract

A higher incidence rate of nocturia in patients with obstructive sleep apnea (OSA) has been observed. We investigated the differences in clinical examinations between OSA patients with and without nocturia, and further compared those with successful and unsuccessful uvulopalatopharyngoplasty (UPPP). This retrospective study [...] Read more.

A higher incidence rate of nocturia in patients with obstructive sleep apnea (OSA) has been observed. We investigated the differences in clinical examinations between OSA patients with and without nocturia, and further compared those with successful and unsuccessful uvulopalatopharyngoplasty (UPPP). This retrospective study enrolled 103 patients with OSA undergoing UPPP. Patients were diagnosed with OSA by following the 2018 American Academy of Sleep Medicine (AASM) Scoring Manual Version 2.5. Patients were divided into two groups depending on if they urinated more than twice per night. The medical data of body mass index (BMI), nocturia frequency per night, apnea–hypopnea index (AHI), Epworth Sleepiness Scale (ESS), International Prostatic Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS) were analyzed before and after uvulopalatopharyngoplasty (UPPP) surgery. All of the measurements were compared between successful and unsuccessful surgery in the non-nocturia or nocturia groups, respectively. Fifty patients (41 males and nine females) without nocturia were assigned to group 1, and 53 patients (43 males and 10 females) with nocturia were assigned to group 2. Nocturia frequency and post-surgery AHI in group 2 were significantly higher than those in group 1 (p < 0.05). Significant decreases in IPSS and OABSS were observed in the successful surgery subgroup of group 2 (p < 0.05). A significant decrease in post-surgery AHI was observed between unsuccessful and successful surgery in patients with nocturia (p < 0.05), but not in the non-nocturia group (p > 0.05). Although AHI had a significant correlation to nocturia frequency in all OSA patients before UPPP, no significant correlation between AHI reduction and nocturia frequency was found. UPPP appeared to be an effective treatment for nocturia associated with OSA. OSA should be taken into consideration for patients who complain of nocturia syndrome. The relationship of AHI reduction and nocturia improvement after OSA treatment with UPPP is still unclear. In addition, it is necessary to establish the existence of nocturia in patients with OSA, as a result of its high prevalence in OSA patients. UPPP could reduce the symptoms of OSA and could also contribute to a reduction of nocturia even in the unsuccessful surgery group. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

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13 pages, 251 KiB

Open AccessArticle

Psychological Profile and Distinct Salivary Cortisol Awake Response (CAR) in Two Different Study Populations with Obstructive Sleep Apnea (OSA) and Central Serous Chorioretinopathy (CSC)

by Fabio Scarinci, Francesca Romana Patacchioli, Cristina Mihaela Ghiciuc, Vittorio Pasquali, Raluca Mihaela Bercea, Sebastian Cozma and Mariacristina Parravano

J. Clin. Med. 2020, 9(8), 2490; https://doi.org/10.3390/jcm9082490 - 03 Aug 2020

Cited by 8 | Viewed by 2546

Abstract

Obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) are in terms of nosography different pathologies, however they share a stress-related physio-pathogenetic component, not yet explored in depth. Therefore, the aim of the present study was to ascertain whether OSA and CSC share [...] Read more.

Obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) are in terms of nosography different pathologies, however they share a stress-related physio-pathogenetic component, not yet explored in depth. Therefore, the aim of the present study was to ascertain whether OSA and CSC share a common profile, specifically in cortisol production focusing on the cortisol awake response (CAR), the area under curve (AUC_CAR) and the SLOPE_CAR compared with healthy matched controls. Furthermore, standardized self-administered questionnaires were used to identify mental health status related to depression, anxiety and subjective stress perception levels in the study populations. The results showed hypothalamus-pituitary-adrenal (HPA) axis activity anomalies, represented by a flattening CAR in the OSA group and a statistically significant increase in cortisol production in CSC patients at awakening. This disarrangement of the HPA axis activity associated with elevated distress and mental health scores, and its presence in both patients with OSA and patients with CSC, might represent the shared path explaining the stress-related component in these diseases. Further research is needed to investigate the psycho-neuro-endocrinological aspects of OSA and CSC to determine whether psychoeducation on effective stress coping strategies might be of value in improving the quality of life of OSA and CSC patients. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

13 pages, 1292 KiB

Open AccessArticle

Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome

by Eusebi Chiner, Cristina Cánovas, Virginia Molina, Jose N. Sancho-Chust, Sandra Vañes, Esther Pastor and Miguel Angel Martinez-Garcia

J. Clin. Med. 2020, 9(7), 2067; https://doi.org/10.3390/jcm9072067 - 01 Jul 2020

Cited by 17 | Viewed by 2496

Abstract

The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome (OSAS). PSG was indicated only in patients with concomitant disease or where HRP results were questionable. The follow-up period [...] Read more.

The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome (OSAS). PSG was indicated only in patients with concomitant disease or where HRP results were questionable. The follow-up period was 1 year. We recorded clinical and anthropometric data, physical examination findings, respiratory variables, severity level and choice of therapy. We assessed 121 children, 70 boys and 51 girls, with mean age 7 ± 4 years, mean body mass index (BMI) 19 ± 5 kg/m², and mean BMI percentile 62 ± 38%. We included 104 HRP and 24 PSG recordings. Of the latter, 7 were preceded by HRP (false negatives) and 17 were indicated as the first-choice method owing to concomitant disease. Of the initial HRP recordings, 93% were technically valid. All technically valid HRPs and 96% of PSGs resulted in a diagnosis of OSAS (apnea-hypopnea index 9.5 ± 9.1/h). Thirty-three percent of cases were moderate and 22% severe. Apnea-hypopnea index showed no correlation with BMI or BMI percentile. Adenotonsillectomy was indicated in 93 patients (77%), conservative treatment in 17 (14%), and conservative treatment combined with CPAP/BiPAP in 11 (9%). There were no significant differences between children diagnosed by HRP and by PSG in terms of treatment choice. The prevalence of OSAS in our sample was 96.7%. In conclusion, when the probability of OSAS is high, HRP is usually sufficient for diagnosing the syndrome and establishing therapy in children. PSG is advisable in complex or questionable cases. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

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Review

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8 pages, 663 KiB

Open AccessReview

Exploring the Biopsychosocial Pathways Shared by Obstructive Sleep Apnea (OSA) and Central Serous Chorioretinopathy (CSC): A Literature Overview

by Fabio Scarinci, Francesca Romana Patacchioli and Mariacristina Parravano

J. Clin. Med. 2021, 10(7), 1521; https://doi.org/10.3390/jcm10071521 - 06 Apr 2021

Cited by 4 | Viewed by 1767

Abstract

This study addressed the following question: “Is it possible to highlight the link between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) through common biopsychosocial pathogenetic pathways?”. The study was conducted through electronic searches of the PubMed, Web of Science, and Scopus [...] Read more.

This study addressed the following question: “Is it possible to highlight the link between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) through common biopsychosocial pathogenetic pathways?”. The study was conducted through electronic searches of the PubMed, Web of Science, and Scopus databases. All relevant selected human research studies published from January 2003 to December 2020 were included. The scientific literature search was performed through repeated use of the words “OSA” and/or “acute/chronic CSC” paired with “biomedical/biopsychosocial illness model”, “psychopathology”, “stress”, “personality characteristics”, “functional diseases”, “comorbidity”, and “quality of life” in different combinations. Our literature search identified 213 reports, of which 54 articles were ultimately reviewed in this paper. Taken together, the results indicate that there is a cross-link between OSA and CSC that can be classified among biopsychological disorders in which various major biological variables integrate with psychological-functional and sociological variables; many of these variables appear in both diseases. This concept can have important implications for improving patients’ quality of life, thus providing the necessary strategies to cope with challenging life events even through nonpharmacological approaches. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

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19 pages, 719 KiB

Open AccessReview

Oxidative Stress and Inflammation Biomarker Expression in Obstructive Sleep Apnea Patients

by Antonino Maniaci, Giannicola Iannella, Salvatore Cocuzza, Claudio Vicini, Giuseppe Magliulo, Salvatore Ferlito, Giovanni Cammaroto, Giuseppe Meccariello, Andrea De Vito, Alice Nicolai, Annalisa Pace, Marco Artico and Samanta Taurone

J. Clin. Med. 2021, 10(2), 277; https://doi.org/10.3390/jcm10020277 - 13 Jan 2021

Cited by 104 | Viewed by 6940

Abstract

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the [...] Read more.

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the upper airways with the persistence of thoracic-diaphragmatic respiratory movements. During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO₂) and a gradual increase in the partial arterial pressure of carbon dioxide (PaCO₂). The direct consequence of the intermittent hypoxia is an oxidative imbalance, with reactive oxygen species production and the inflammatory cascade’s activation with pro and anti-inflammatory cytokines growth. Tumour necrosis factors, inflammatory cytokines (IL2, IL4, IL6), lipid peroxidation, and cell-free DNA have been found to increase in OSAS patients. However, even though different risk-related markers have been described and analysed in the literature, it has not yet been clarified whether specified inflammatory bio-markers better correlates with OSAS diagnosis and its clinical evolution/comorbidities. We perform a scientific literature review to discuss inflammatory and oxidative stress biomarkers currently tested in OSAS patients and their correlation with the disease’s severity and treatment. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

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Other

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7 pages, 4019 KiB

Open AccessPerspective

Alternative Procedure to Individual Nasal Pressure Titration for Sleep Apnea

by Ramon Farré, David Gozal and Josep M. Montserrat

J. Clin. Med. 2021, 10(7), 1453; https://doi.org/10.3390/jcm10071453 - 01 Apr 2021

Cited by 5 | Viewed by 1649

Abstract

In the treatment of obstructive sleep apnea (OSA), the current standard of “CPAP titration” in the laboratory or at home is a resource demanding and costly approach that, in developed economies, markedly augments healthcare costs and in low resource economies precludes access to [...] Read more.

In the treatment of obstructive sleep apnea (OSA), the current standard of “CPAP titration” in the laboratory or at home is a resource demanding and costly approach that, in developed economies, markedly augments healthcare costs and in low resource economies precludes access to care altogether. Here, we discuss that current guidelines for titration of CPAP could be obviated by taking a different route that in many ways is similar to the institution of treatment in many other medical conditions. To this effect, we present novel population based data from 16,780 patients, showing that after individualized and labor-intensive and expensive CPAP titration, 86.4% of OSA patients are treated with nasal pressure settings within the range of 9 ± 2 cmH₂O, and review the literature to justify the potential adoption of a standard therapeutic CPAP setting as the initial intervention which would be subsequently followed by any necessary adjustments in only a minority of patients who would not derive the necessary benefit from such standardized intervention. Assuming an 80–85% success rate as derived from our analyses, our personal view if extensively adopted could radically reduce healthcare costs and enable markedly improve access to diagnostics. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome: Pathogenesis, Treatments and Comorbidity)

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