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Bordas-Martinez J, Salord N, Vicens-Zygmunt V, Carmezim J, Pérez S, Prado E, Calvo M, Blavia R, Bermudo G, Santos S, Monasterio C, Molina-Molina M. Treating sleep-disordered breathing of idiopathic pulmonary fibrosis patients with CPAP and nocturnal oxygen treatment. A pilot study : Sleep-disordered breathing treatment in IPF. Respir Res 2024; 25:247. [PMID: 38890648 PMCID: PMC11186220 DOI: 10.1186/s12931-024-02871-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Sleep-disordered breathing (SDB) is a major comorbidity in idiopathic pulmonary fibrosis (IPF) and is associated with a poor outcome. There is a lack of knowledge regarding the impact of SDB treatment on IPF. We assessed at one year: (1) the effect of CPAP and/or nocturnal oxygen therapy on IPF regarding lung function, blood mediators, and quality of life; (2) adherence to SDB treatment and SDB changes. METHODOLOGY This is a prospective study of consecutive newly diagnosed IPF patients initiating anti-fibrotic treatment. Lung function, polysomnography, blood tests and quality of life questionnaires were performed at inclusion and after one year. Patients were classified as obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and sleep-sustained hypoxemia (SSH). SDB therapy (CPAP and/or nocturnal oxygen therapy) was initiated if needed. RESULTS Fifty patients were enrolled (36% had OSA, 22% CSA, and 12% SSH). CPAP was started in 54% of patients and nocturnal oxygen therapy in 16%. At one-year, polysomnography found improved parameters, though 17% of patients had to add nocturnal oxygen therapy or CPAP, while 33% presented SDB onset at this second polysomnography. CPAP compliance at one year was 6.74 h/night (SD 0.74). After one year, matrix metalloproteinase-1 decreased in OSA and CSA (p = 0.029; p = 0.027), C-reactive protein in OSA (p = 0.045), and surfactant protein D in CSA group (p = 0.074). There was no significant change in lung function. CONCLUSIONS Treatment of SBD with CPAP and NOT can be well tolerated with a high compliance. IPF patients may exhibit SDB progression and require periodic re-assessment. Further studies to evaluate the impact of SDB treatment on lung function and serological mediators are needed.
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Affiliation(s)
- Jaume Bordas-Martinez
- Interstitial Lung Disease Unit, Respiratory Department, Bellvitge University Hospital. IDIBELL. CIBERES, University of Barcelona. -Hospitalet de Llobregat (Barcelona), Barcelona, Spain
- Sleep Unit, Respiratory Department, Bellvitge University Hospital, IDIBELL. University of Barcelona. - Hospitalet de Llobregat (Barcelona), 08907, Barcelona, Spain
- Respiratory Department, Granollers University Hospital. -Granollers (Barcelona), Barcelona, Spain
| | - Neus Salord
- Sleep Unit, Respiratory Department, Bellvitge University Hospital, IDIBELL. University of Barcelona. - Hospitalet de Llobregat (Barcelona), 08907, Barcelona, Spain
| | - Vanesa Vicens-Zygmunt
- Interstitial Lung Disease Unit, Respiratory Department, Bellvitge University Hospital. IDIBELL. CIBERES, University of Barcelona. -Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - João Carmezim
- Biostatistics Unit, IDIBELL. Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Sandra Pérez
- Sleep Unit, Respiratory Department, Bellvitge University Hospital, IDIBELL. University of Barcelona. - Hospitalet de Llobregat (Barcelona), 08907, Barcelona, Spain
| | - Eliseo Prado
- Sleep Unit, Respiratory Department, Bellvitge University Hospital, IDIBELL. University of Barcelona. - Hospitalet de Llobregat (Barcelona), 08907, Barcelona, Spain
| | - María Calvo
- Sleep Unit, Respiratory Department, Bellvitge University Hospital, IDIBELL. University of Barcelona. - Hospitalet de Llobregat (Barcelona), 08907, Barcelona, Spain
| | - Rosana Blavia
- Respiratory Department, Hospital Moises Broggi. -Sant Joan Despí, Barcelona, Spain
| | - Guadalupe Bermudo
- Interstitial Lung Disease Unit, Respiratory Department, Bellvitge University Hospital. IDIBELL. CIBERES, University of Barcelona. -Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Salud Santos
- Interstitial Lung Disease Unit, Respiratory Department, Bellvitge University Hospital. IDIBELL. CIBERES, University of Barcelona. -Hospitalet de Llobregat (Barcelona), Barcelona, Spain
| | - Carmen Monasterio
- Sleep Unit, Respiratory Department, Bellvitge University Hospital, IDIBELL. University of Barcelona. - Hospitalet de Llobregat (Barcelona), 08907, Barcelona, Spain.
| | - María Molina-Molina
- Interstitial Lung Disease Unit, Respiratory Department, Bellvitge University Hospital. IDIBELL. CIBERES, University of Barcelona. -Hospitalet de Llobregat (Barcelona), Barcelona, Spain
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Rozenberg D, Reid WD, Camp P, Campos JL, Dechman G, Davenport PW, Egan H, Fisher JH, Guenette JA, Gold D, Goldstein RS, Goodridge D, Janaudis-Ferreira T, Kaplan AG, Langer D, Marciniuk DD, Moore B, Orchanian-Cheff A, Otoo-Appiah J, Pepin V, Rassam P, Rotenberg S, Ryerson C, Spruit MA, Stanbrook MB, Stickland MK, Tom J, Wentlandt K. Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review. Chest 2024:S0012-3692(24)00707-4. [PMID: 38901488 DOI: 10.1016/j.chest.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/22/2024] Open
Abstract
TOPIC IMPORTANCE Cognitive and physical limitations are common in individuals with chronic lung diseases, but their interactions with physical function and activities of daily living are not well characterized. Understanding these interactions and potential contributors may provide insights on disability and enable more tailored rehabilitation strategies. REVIEW FINDINGS This review summarizes a 2-day meeting of patient partners, clinicians, researchers, and lung associations to discuss the interplay between cognitive and physical function in people with chronic lung diseases. This report covers four areas: (1) cognitive-physical limitations in patients with chronic lung diseases; (2) cognitive assessments; (3) strategies to optimize cognition and motor control; and (4) future research directions. Cognitive and physical impairments have multiple effects on quality of life and daily function. Meeting participants acknowledged the need for a standardized cognitive assessment to complement physical assessments in patients with chronic lung diseases. Dyspnea, fatigue, and age were recognized as important contributors to cognition that can affect motor control and daily physical function. Pulmonary rehabilitation was highlighted as a multidisciplinary strategy that may improve respiratory and limb motor control through neuroplasticity and has the potential to improve physical function and quality of life. SUMMARY There was consensus that cognitive function and the cognitive interference of dyspnea in people with chronic lung diseases contribute to motor control impairments that can negatively affect daily function, which may be improved with pulmonary rehabilitation. The meeting generated several key research questions related to cognitive-physical interactions in individuals with chronic lung diseases.
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Affiliation(s)
- Dmitry Rozenberg
- Temerty Faculty of Medicine, Respirology, Krembil Brain Institute, Toronto, ON, Canada; Respirology, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
| | - W Darlene Reid
- Department of Physical Therapy, Krembil Brain Institute, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, Krembil Brain Institute, Toronto, ON, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Pat Camp
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, The University of British Columbia, Vancouver, BC, Canada
| | - Jennifer L Campos
- Department of Psychology, Krembil Brain Institute, Toronto, ON, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Gail Dechman
- School of Physiotherapy, Faculty of Health, Dalhousie University; Department of Medicine, Respirology, Nova Scotia Health Authority
| | | | - Helga Egan
- Lung Health Foundation, Toronto, ON, Canada
| | - Jolene H Fisher
- Temerty Faculty of Medicine, Respirology, Krembil Brain Institute, Toronto, ON, Canada; Respirology, University Health Network, Toronto, ON, Canada
| | - Jordan A Guenette
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St Paul's Hospital, Vancouver, BC, Canada; Division of Respiratory Medicine, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, Canada
| | - David Gold
- Department of Psychiatry, Krembil Brain Institute, Toronto, ON, Canada; Neuropsychology Clinic, University Health Network, Toronto, ON, Canada
| | - Roger S Goldstein
- Temerty Faculty of Medicine, Respirology, Krembil Brain Institute, Toronto, ON, Canada; Department of Respiratory Medicine, Westpark Healthcare Centre, Toronto, ON, Canada
| | - Donna Goodridge
- College of Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Alan G Kaplan
- Department of Family and Community Medicine, School of Graduate Studies, Temerty Faculty of Medicine, Toronto, ON, Canada; Family Physician Airways Group of Canada
| | - Daniel Langer
- KU Leuven, Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium; Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Darcy D Marciniuk
- Division of Respirology, Critical Care and Sleep Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Jessica Otoo-Appiah
- Department of Physical Therapy, Krembil Brain Institute, Toronto, ON, Canada
| | - Veronique Pepin
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QB, Canada
| | - Peter Rassam
- Department of Physical Therapy, Krembil Brain Institute, Toronto, ON, Canada; Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Shlomit Rotenberg
- Department of Occupational Science & Occupational Therapy, Rehabilitation Sciences Institute, Toronto, ON, Canada; Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | - Chris Ryerson
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St Paul's Hospital, Vancouver, BC, Canada
| | - Martijn A Spruit
- Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Matthew B Stanbrook
- Temerty Faculty of Medicine, Respirology, Krembil Brain Institute, Toronto, ON, Canada; Respirology, University Health Network, Toronto, ON, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada
| | | | - Kirsten Wentlandt
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Supportive Care, University Health Network, Toronto, ON, Canada
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Melani AS, Croce S, Messina M, Bargagli E. Untreated Obstructive Sleep Apnea in Interstitial Lung Disease and Impact on Interstitial Lung Disease Outcomes. Sleep Med Clin 2024; 19:283-294. [PMID: 38692753 DOI: 10.1016/j.jsmc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Subjects with interstitial lung disease (ILD) often suffer from nocturnal cough, insomnia, and poor sleep quality. Subjects with ILD and obstructive sleep apnea (OSA) seem to have relatively mild symptoms from sleep fragmentation compared to subjects with only ILD. The overlap of ILD, OSA, and sleeping hypoxemia may be associated with poor outcome, even though there is no agreement on which sleep parameter is mostly associated with worsening ILD prognosis. Randomized controlled trials are needed to understand when positive airway pressure (PAP) treatment is required in subjects with ILD and OSA and the impact of PAP treatment on ILD progression.
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Affiliation(s)
- Andrea S Melani
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena 53100, Italy.
| | - Sara Croce
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena 53100, Italy
| | - Maddalena Messina
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena 53100, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena 53100, Italy
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Annaka H, Nomura T, Moriyama H. Cognitive Function in Patients With Mild Idiopathic Pulmonary Fibrosis: A Case-Control Pilot Study. Occup Ther Health Care 2024:1-15. [PMID: 38440879 DOI: 10.1080/07380577.2024.2324256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/24/2024] [Indexed: 03/06/2024]
Abstract
This case-control study examined cognitive function in patients with mild idiopathic pulmonary fibrosis (IPF), in comparison with controls or moderate-to-severe IPF. Ten mild IPF, 10 moderate-to-severe IPF, and 16 controls were enrolled, and performance on seven different cognitive function tests was compared in each group. IPF showed decreased cognitive function compared to controls in verbal memory, cognitive flexibility and information processing speed. As the scores were lower even in mild IPF, this study suggests that cognitive function declines early in the disease process of IPF. Thus, occupational therapy for IPF should require an assessment of cognitive function and assistance appropriate to the client's function.
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Affiliation(s)
- Hiroki Annaka
- Department of Occupational Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomonori Nomura
- Department of Occupational Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiroshi Moriyama
- Department of Respiratory Medicine, National Hospital Organization, Nishiniigata Chuo Hospital, Niigata, Japan
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Wu X, Xiao X, Fang H, He C, Wang H, Wang M, Lan P, Wang F, Du Q, Yang H. Elucidating shared biomarkers in gastroesophageal reflux disease and idiopathic pulmonary fibrosis: insights into novel therapeutic targets and the role of angelicae sinensis radix. Front Pharmacol 2024; 15:1348708. [PMID: 38414734 PMCID: PMC10897002 DOI: 10.3389/fphar.2024.1348708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Abstract
Background: The etiological underpinnings of gastroesophageal reflux disease (GERD) and idiopathic pulmonary fibrosis (IPF) remain elusive, coupled with a scarcity of effective therapeutic interventions for IPF. Angelicae sinensis radix (ASR, also named Danggui) is a Chinese herb with potential anti-fibrotic properties, that holds promise as a therapeutic agent for IPF. Objective: This study seeks to elucidate the causal interplay and potential mechanisms underlying the coexistence of GERD and IPF. Furthermore, it aims to investigate the regulatory effect of ASR on this complex relationship. Methods: A two-sample Mendelian randomization (TSMR) approach was employed to delineate the causal connection between gastroesophageal reflux disease and IPF, with Phennoscanner V2 employed to mitigate confounding factors. Utilizing single nucleotide polymorphism (SNPs) and publicly available microarray data, we analyzed potential targets and mechanisms related to IPF in GERD. Network pharmacology and molecular docking were employed to explore the targets and efficacy of ASR in treating GERD-related IPF. External datasets were subsequently utilized to identify potential diagnostic biomarkers for GERD-related IPF. Results: The IVW analysis demonstrated a positive causal relationship between GERD and IPF (IVW: OR = 1.002, 95%CI: 1.001, 1.003; p < 0.001). Twenty-five shared differentially expressed genes (DEGs) were identified. GO functional analysis revealed enrichment in neural, cellular, and brain development processes, concentrated in chromosomes and plasma membranes, with protein binding and activation involvement. KEGG analysis unveiled enrichment in proteoglycan, ERBB, and neuroactive ligand-receptor interaction pathways in cancer. Protein-protein interaction (PPI) analysis identified seven hub genes. Network pharmacology analysis demonstrated that 104 components of ASR targeted five hub genes (PDE4B, DRD2, ERBB4, ESR1, GRM8), with molecular docking confirming their excellent binding efficiency. GRM8 and ESR1 emerged as potential diagnostic biomarkers for GERD-related IPF (ESR1: AUCGERD = 0.762, AUCIPF = 0.725; GRM8: AUCGERD = 0.717, AUCIPF = 0.908). GRM8 and ESR1 emerged as potential diagnostic biomarkers for GERD-related IPF, validated in external datasets. Conclusion: This study establishes a causal link between GERD and IPF, identifying five key targets and two potential diagnostic biomarkers for GERD-related IPF. ASR exhibits intervention efficacy and favorable binding characteristics, positioning it as a promising candidate for treating GERD-related IPF. The potential regulatory mechanisms may involve cell responses to fibroblast growth factor stimulation and steroidal hormone-mediated signaling pathways.
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Affiliation(s)
- Xuanyu Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Xiao
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hanyu Fang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Cuifang He
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hanyue Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Miao Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Peishu Lan
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fei Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Quanyu Du
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Han Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Schiza S, Schwarz EI, Bonsignore MR, McNicholas WT, Pataka A, Bouloukaki I. Co-existence of OSA and respiratory diseases and the influence of gender. Expert Rev Respir Med 2023; 17:1221-1235. [PMID: 38198636 DOI: 10.1080/17476348.2024.2304065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung disease. AREAS COVERED This narrative review aims to comprehensively synthesize the existing information on SDB in respiratory diseases, investigate the role of gender in this association, and highlight the importance of OSA management in improving sleep, quality of life, and disease prognosis in these specific patient populations. EXPERT OPINION Research indicates a synergistic link between OSA and chronic respiratory diseases, which leads to greater morbidity and mortality compared to each disorder alone. Given the lack of an optimal OSA screening tool for these patients, a comprehensive patient approach and overnight diagnostic sleep study are imperative. Despite the limited evidence available, it seems that gender has an impact on the prevalence, severity, and susceptibility of this coexistence. Recognizing the role of gender in the coexistence of OSA and other respiratory diseases can enhance everyday medical practice and enable clinicians to adopt a more personalized approach toward optimal screening and diagnosis of these patients.
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete School of Medicine, Crete, Greece
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zurich and University of Zurich, University of Zurich Faculty of Medicine, Zurich, Switzerland
| | - Maria R Bonsignore
- Division of Respiratory Medicine, PROMISE Department, University of Palermo Faculty of Medicine and Surgery, Palermo, Italy
| | - Walter T McNicholas
- Department of Respiratory and Sleep Medicine, St Vincent's Hospital Group, University College Dublin, Dublin, Ireland
| | - Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital, Medical School, Aristoteleio Panepistemio Thessalonikes Schole Epistemon Ygeias, Thessaloniki, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete School of Medicine, Crete, Greece
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Annaka H, Nomura T, Moriyama H. Association between cognitive decline and activities of daily living decline in patients undergoing long-term oxygen therapy: a prospective observational pilot study. Disabil Rehabil 2023; 45:3493-3499. [PMID: 36171683 DOI: 10.1080/09638288.2022.2127934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Patients undergoing long-term oxygen therapy (LTOT) are predisposed to progressive cognitive decline; however, the association between cognitive decline progression and activities of daily living (ADL) decline has not been described. We aimed to describe the association between cognitive decline progression and ADL decline in patients undergoing LTOT. MATERIALS AND METHODS In this prospective observational pilot study, data were collected at baseline and 1-year following the ambulatory recruitment of patients in the Department of Respiratory Medicine at the National Hospital Organization Nishiniigata Chuo Hospital. We recruited 96 patients with chronic respiratory disease undergoing LTOT, and 55 patients who completed a 1-year follow-up were finally included. RESULTS Multivariate logistic regression analysis revealed that Montreal Cognitive Assessment score reduction (a measure of cognitive decline) was associated with Barthel index score reduction (a measure of ADL) at 1-year follow-up (odds ratio: 3.98; 95% confidence interval: 1.16 - 13.69; p = 0.02). CONCLUSION A progression of cognitive decline in patients undergoing LTOT may affect ADL decline. An early detection of cognitive decline in patients undergoing LTOT is essential for ADL maintenance in rehabilitation practice.IMPLICATIONS FOR REHABILITATIONPatients undergoing long-term oxygen therapy (LTOT) present with progressive cognitive decline.Cognitive decline progression is associated with a decline in activities of daily living in patients undergoing LTOT.A periodic cognitive assessment is important in rehabilitation practice for the early detection of progressive cognitive decline in patients undergoing LTOT.
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Affiliation(s)
- Hiroki Annaka
- Department of Occupational Therapy, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Niigata, Japan
- Graduate School, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Tomonori Nomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata, Niigata, Japan
| | - Hiroshi Moriyama
- Respiratory Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Niigata, Japan
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Hanada M, Tanaka T, Kozu R, Ishimatsu Y, Sakamoto N, Orchanian-Cheff A, Rozenberg D, Reid WD. The interplay of physical and cognitive function in rehabilitation of interstitial lung disease patients: a narrative review. J Thorac Dis 2023; 15:4503-4521. [PMID: 37691666 PMCID: PMC10482628 DOI: 10.21037/jtd-23-209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/04/2023] [Indexed: 09/12/2023]
Abstract
Background and Objective Interstitial lung disease (ILD) encompasses several diverse pulmonary pathologies that result in abnormal diffuse parenchymal changes. When prescribing rehabilitation, several additional factors need to be considered as a result of aging, polypharmacy, and comorbidities manifested in ILD patients. This review aims to discuss issues related to frailty, skeletal muscle and cognitive function that limit physical activities in ILD patients. It will also highlight exercise training and propose complementary strategies for pulmonary rehabilitation. Methods A literature search was performed in MEDLINE, CINAHL (inception to October 19th, 2022) using search terms based on concepts of: idiopathic pulmonary fibrosis or interstitial lung disease; frailty; muscular atrophy; skeletal muscle dysfunction; cognitive dysfunction; sleep quality; sleep disorders; anxiety disorders; or depressive disorders. After eligible texts were screened, additional references were included from references cited in the screened articles. Key Content and Findings Frailty and skeletal muscle dysfunction are common in ILD. Weight loss, exhaustion, and anti-fibrotic medications can impact frailty, whereas physical inactivity, aging, corticosteroids and hypoxemia can contribute to sarcopenia (loss of muscle mass and function). Frailty is associated with worse clinical status, exercise intolerance, skeletal muscle dysfunction, and decreased quality of life in ILD. Sarcopenia appears to influence wellbeing and can potentially affect overall physical conditioning, cognitive function and the progression of ILD. Optimal assessment tools and effective strategies to prevent and counter frailty and sarcopenia need to be determined in ILD patients. Even though cognitive impairment is evident in ILD, its prevalence and underlying neurobiological model of contributing factors (i.e., inflammation, disease severity, cardiopulmonary status) requires further investigation. How ILD affects cognitive interference, motor control and consequently physical daily activities is not well defined. Strategies such as pulmonary rehabilitation, which primarily focuses on strength and aerobic conditioning have demonstrated improvements in ILD patient outcomes. Future incorporation of interval training and the integration of motor learning could improve transfer of rehabilitation strategies to daily activities. Conclusions Numerous underlying etiologies of ILD contribute to frailty, skeletal muscle and cognitive function, but their respective neurobiologic mechanisms require further investigation. Exercise training increases physical measures, but complementary approaches may improve their applicability to improve daily activities.
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Affiliation(s)
- Masatoshi Hanada
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takako Tanaka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuji Ishimatsu
- Department of Nursing, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Respirology, Ajmera Transplant Program, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - W. Darlene Reid
- Department of Physical Therapy, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
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Valecchi D, Bargagli E, Pieroni MG, Refini MR, Sestini P, Rottoli P, Melani AS. Prognostic Significance of Obstructive Sleep Apnea in a Population of Subjects with Interstitial Lung Diseases. Pulm Ther 2023; 9:223-236. [PMID: 36790678 DOI: 10.1007/s41030-023-00215-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is often observed in subjects with interstitial lung disease (ILD). It may have a negative impact on the course of ILD, but its prognostic significance in relation to other known indicators of poor outcome is unclear. METHODS After a detailed work-up, including overnight unattended type III polygraphy, all subjects newly diagnosed with ILDs referred to our clinics were followed-up for at least 1.5 years or until death or progression of disease [> 10% decline in forced vital capacity (FVC) below baseline]. We analyzed relationships between some prespecified variables of interest, including sleeping results, to establish parameters predictive of progressive course. RESULTS Our population consisted of 46 subjects (mean age 59.6 years; males 61%); 23.9% and 41% had idiopathic pulmonary fibrosis and ILD associated with systemic diseases, respectively. Mean baseline forced vital capacity and diffusion capacity of carbon monoxide were 83% and 57% of predicted, respectively. Mean (± SE) Apnea-Hypopnea Index (AHI) was 17 (± 3) events/h. AHI in the ranges 5-14.9, 15-29.9, and ≥ 30 was recorded in 14 (31%), 6 (13%), and 9 (20%) subjects, respectively. Mean distance covered in the 6-MWG walk test (6MWT) was 302 (± 19) m and 26 subjects (57%) showed exertional oxyhemoglobin desaturation. The median follow-up was about 18 months. Multivariate logistic regression analysis showed that exertional desaturation (HR 8.2; 1.8-36.5 95% CI; p = 0.006) and AHI ≥ 30, namely the threshold of severe OSA (HR 7.5; 1.8-30.6; p = 0.005), were the only independent variables related to progressive disease course. CONCLUSION We conclude that exertional desaturation and elevated AHI had independent negative prognostic significance in our ILD population.
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Affiliation(s)
- Debora Valecchi
- Department of Medical Science, Surgery and Neuroscience, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Elena Bargagli
- Department of Medical Science, Surgery and Neuroscience, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Maria Grazia Pieroni
- Department of Medical Science, Surgery and Neuroscience, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Metella Rosa Refini
- Department of Medical Science, Surgery and Neuroscience, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Piersante Sestini
- Department of Medical Science, Surgery and Neuroscience, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Paola Rottoli
- Department of Medical Science, Surgery and Neuroscience, Respiratory Diseases and Lung Transplant Unit, University of Siena, Siena, Italy
| | - Andrea S Melani
- Dipartimento di Scienze Mediche, Laboratorio per lo Studio dei Disturbi Respiratori Sonno-Correlati, Respiratory Diseases and Lung Transplant Unit, Policlinico Le Scotte, CMR, Azienda Ospedaliera Universitaria Senese, Viale Bracci, 53100, Siena, Italy.
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10
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Li Z, Wang S, Zhao H, Yan P, Yuan H, Zhao M, Wan R, Yu G, Wang L. Artificial neural network identified the significant genes to distinguish Idiopathic pulmonary fibrosis. Sci Rep 2023; 13:1225. [PMID: 36681777 PMCID: PMC9867697 DOI: 10.1038/s41598-023-28536-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease that causes irreversible damage to lung tissue characterized by excessive deposition of extracellular matrix (ECM) and remodeling of lung parenchyma. The current diagnosis of IPF is complex and usually completed by a multidisciplinary team including clinicians, radiologists and pathologists they work together and make decision for an effective treatment, it is imperative to introduce novel practical methods for IPF diagnosis. This study provided a new diagnostic model of idiopathic pulmonary fibrosis based on machine learning. Six genes including CDH3, DIO2, ADAMTS14, HS6ST2, IL13RA2, and IGFL2 were identified based on the differentially expressed genes in IPF patients compare to healthy subjects through a random forest classifier with the existing gene expression databases. An artificial neural network model was constructed for IPF diagnosis based these genes, and this model was validated by the distinctive public datasets with a satisfactory diagnostic accuracy. These six genes identified were significant correlated with lung function, and among them, CDH3 and DIO2 were further determined to be significantly associated with the survival. Putting together, artificial neural network model identified the significant genes to distinguish idiopathic pulmonary fibrosis from healthy people and it is potential for molecular diagnosis of IPF.
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Affiliation(s)
- Zhongzheng Li
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China
| | - Shenghui Wang
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China
| | - Huabin Zhao
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China
| | - Peishuo Yan
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China
| | - Hongmei Yuan
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China
| | - Mengxia Zhao
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China
| | - Ruyan Wan
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China
| | - Guoying Yu
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China.
| | - Lan Wang
- State Key Laboratory of Cell Differentiation and Regulation, Henan International Joint Laboratory of Pulmonary Fibrosis, Henan Center for Outstanding Overseas Scientists of Pulmonary Fibrosis, College of Life Science, Henan Normal University, 46 Jianshe Road, Xinxiang, 453007, Henan, China.
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11
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Mohammadi-Nejad AR, Allen RJ, Kraven LM, Leavy OC, Jenkins RG, Wain LV, Auer DP, Sotiropoulos SN. Mapping brain endophenotypes associated with idiopathic pulmonary fibrosis genetic risk. EBioMedicine 2022; 86:104356. [PMID: 36413936 PMCID: PMC9677133 DOI: 10.1016/j.ebiom.2022.104356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/16/2022] [Accepted: 10/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a serious disease of the lung parenchyma. It has a known polygenetic risk, with at least seventeen regions of the genome implicated to date. Growing evidence suggests linked multimorbidity of IPF with neurodegenerative or affective disorders. However, no study so far has explicitly explored links between IPF, associated genetic risk profiles, and specific brain features. METHODS We exploited imaging and genetic data from more than 32,000 participants available through the UK Biobank population-level resource to explore links between IPF genetic risk and imaging-derived brain endophenotypes. We performed a brain-wide imaging-genetics association study between the presence of 17 known IPF risk variants and 1248 multi-modal imaging-derived features, which characterise brain structure and function. FINDINGS We identified strong associations between cortical morphological features, white matter microstructure and IPF risk loci in chromosomes 17 (17q21.31) and 8 (DEPTOR). Through co-localisation analysis, we confirmed that cortical thickness in the anterior cingulate and more widespread white matter microstructure changes share a single causal variant with IPF at the chromosome 8 locus. Post-hoc preliminary analysis suggested that forced vital capacity may partially mediate the association between the DEPTOR variant and white matter microstructure, but not between the DEPTOR risk variant and cortical thickness. INTERPRETATION Our results reveal the associations between IPF genetic risk and differences in brain structure, for both cortex and white matter. Differences in tissue-specific imaging signatures suggest distinct underlying mechanisms with focal cortical thinning in regions with known high DEPTOR expression, unrelated to lung function, and more widespread microstructural white matter changes consistent with hypoxia or neuroinflammation with potential mediation by lung function. FUNDING This study was supported by the NIHR Nottingham Biomedical Research Centre and the UK Medical Research Council.
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Affiliation(s)
- Ali-Reza Mohammadi-Nejad
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre & Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Richard J Allen
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Luke M Kraven
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Olivia C Leavy
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom; National Institute for Health Research (NIHR) Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Dorothee P Auer
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre & Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
| | - Stamatios N Sotiropoulos
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham, United Kingdom; Sir Peter Mansfield Imaging Centre & Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
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12
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Bouloukaki I, Fanaridis M, Testelmans D, Pataka A, Schiza S. Overlaps between obstructive sleep apnoea and other respiratory diseases, including COPD, asthma and interstitial lung disease. Breathe (Sheff) 2022; 18:220073. [PMID: 36865659 PMCID: PMC9973497 DOI: 10.1183/20734735.0073-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
In the past, there was limited research relating to the role of sleep in respiratory diseases. Physicians treating these patients tended to focus mainly on the daily disabling symptoms, overlooking the possible significant role of coexisting sleep disorders such as obstructive sleep apnoea (OSA). Nowadays, OSA has been recognised as an important, highly prevalent comorbidity for respiratory diseases such as COPD, asthma and interstitial lung diseases (ILDs). Overlap syndrome refers to the coexistence of chronic respiratory disease and OSA in the same patient. Although, in the past, overlap syndromes have been poorly studied, recent data underline that they result in increased morbidity and mortality compared with either underlying disorder alone. OSA and respiratory disease may be of different severity, and this, along with the existence of various clinical phenotypes, points to the necessity of an individualised therapeutic plan. Early recognition and OSA management could offer key benefits, such as improved sleep, quality of life and disease outcomes. Educational aims Describe pathophysiological aspects of OSA in chronic respiratory diseases such as COPD, asthma and ILDs.Understand the bidirectional clinical importance when OSA coexists in chronic respiratory diseases.Review current knowledge of treatment strategies towards an individualised therapeutic plan resulting in patient-centric outcomes.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Michail Fanaridis
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sophia Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece,Corresponding author: Sophia Schiza ()
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13
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The Association between Idiopathic Pulmonary Fibrosis and Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11175008. [PMID: 36078938 PMCID: PMC9457448 DOI: 10.3390/jcm11175008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022] Open
Abstract
The prevalence of obstructive sleep apnea (OSA) has greatly increased in recent years. Recent data suggest that severe and moderate forms of OSA affect between 6 and 17% of adults in the general population. Many papers are reporting the significantly increased prevalence of OSA in patients suffering from fibrotic diseases, including idiopathic pulmonary fibrosis (IPF). Therefore, we performed a systematic review and meta-analysis regarding the dependency between IPF and OSA. Due to the lack of papers focusing on IPF among OSA patients, we focused on the prevalence of OSA among IPF patients. In the search strategy, a total of 684 abstracts were identified, 496 after the removal of duplicates. After the screening of titles and abstracts, 31 studies were qualified for further full-text analysis for eligibility criteria. The final analysis was performed on 614 IPF patients from 18 studies, which met inclusion criteria. There were 469 (76.38%) IPF patients with OSA and 145 (23.62%) without. The mean age varied from 60.9 ± 8.1 up to 70.3 ± 7.9. The obtained prevalence was 76.4 (95% CI: 72.9–79.7) and 75.7 (95% CI: 70.1–80.9) for fixed and random effects, respectively. The median prevalence of OSA among non-IPF patients for all the ethnics groups included in this study was 16,4% (IQR: 3.4%–26.8%). The study provides strong evidence for the increased prevalence of OSA in IPF patients when comparing with the general OSA prevalence.
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14
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Papadogiannis G, Bouloukaki I, Mermigkis C, Michelakis S, Ermidou C, Mauroudi E, Moniaki V, Tzanakis N, Antoniou KM, Schiza SE. Patients with idiopathic pulmonary fibrosis with and without obstructive sleep apnea: differences in clinical characteristics, clinical outcomes, and the effect of PAP treatment. J Clin Sleep Med 2021; 17:533-544. [PMID: 33108270 DOI: 10.5664/jcsm.8932] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF) is associated with worse mortality and clinical outcome. We aimed to assess differences between patients with IPF with and without OSA and the effect of positive airway pressure treatment on sleep and overall life quality, morbidity, and mortality in these patients. METHODS Forty-five patients with newly diagnosed IPF underwent polysomnography. Using an apnea-hypopnea index ≥ 15 events/h for OSA diagnosis resulted in 16 patients with IPF and 29 with IPF-OSA. The patients completed the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Functional Outcomes in Sleep Questionnaire, Fatigue Severity Scale, Short Form-36 life questionnaire, and Beck Depression Inventory before and at the end of the follow-up period. RESULTS Patients with IPF-OSA showed the most severe functional impairments in questionnaires, especially for General Health component of the Short Form-36 life questionnaire (37 vs 58, P = .03). At the 7-year follow-up, 16 (36%) patients had died, 6 (38%) in the IPF group and 10 (35%) in IPF-OSA group. Patients with ≥6-hour positive airway pressure use had better survival compared with patients with <6-hour use (P = .04). Significant improvement was also observed in Epworth Sleepiness Scale (3 vs 6, P = .03), Pittsburgh Sleep Quality Index (5 vs 8, P = .01), and Fatigue Severity Scale (37 vs 48, P = .008) score in patients with ≥4-hour positive airway pressure use. CONCLUSIONS OSA plays a significant role on clinical features and quality of life in patients with IPF. Effective positive airway pressure treatment results in a significant improvement in sleepiness, fatigue, sleep quality, and mortality. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: CPAP Therapy in Patients With Idiopathic Pulmonary Fibrosis and Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/record/NCT01637831; Identifier: NCT01637831.
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Affiliation(s)
- George Papadogiannis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Charalampos Mermigkis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Stylianos Michelakis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Christina Ermidou
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Eleni Mauroudi
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Tzanakis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Interstitial Lung Disease Unit, Pneumonology Molecular & Cellular Lab, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Sophia E Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
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Sanz-Rubio D, Khalyfa A, Qiao Z, Ullate J, Marin JM, Kheirandish-Gozal L, Gozal D. Cell-Selective Altered Cargo Properties of Extracellular Vesicles Following In Vitro Exposures to Intermittent Hypoxia. Int J Mol Sci 2021; 22:ijms22115604. [PMID: 34070558 PMCID: PMC8198838 DOI: 10.3390/ijms22115604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/09/2021] [Accepted: 05/19/2021] [Indexed: 01/09/2023] Open
Abstract
Intermittent hypoxia (IH), a hallmark of obstructive sleep apnea (OSA), is associated with cardiovascular and metabolic dysfunction. However, the mechanisms underlying these morbidities remain poorly delineated. Extracellular vesicles (EVs) mediate intercellular communications, play pivotal roles in a multitude of physiological and pathological processes, and could mediate IH-induced cellular effects. Here, the effects of IH on human primary cells and the release of EVs were examined. Microvascular endothelial cells (HMVEC-d), THP1 monocytes, THP1 macrophages M0, THP1 macrophages M1, THP1 macrophages M2, pre-adipocytes, and differentiated adipocytes (HAd) were exposed to either room air (RA) or IH for 24 h. Secreted EVs were isolated and characterized using transmission electron microscopy, nanoparticle tracking analysis, and Western blotting. The effects of each of the cell-derived EVs on endothelial cell (EC) monolayer barrier integrity, on naïve THP1 macrophage polarity, and on adipocyte insulin sensitivity were also evaluated. IH did not alter EVs cell quantal release, but IH-EVs derived from HMVEC-d (p < 0.01), THP1 M0 (p < 0.01) and HAd (p < 0.05) significantly disrupted HMVEC-d monolayer integrity, particularly after H2O2 pre-conditioning. IH-EVs from HMVEC-d and THP1 M0 elicited M2-polarity changes did not alter insulin sensitivity responses. IH induces cell-selective changes in EVs cargo, which primarily seem to target the emergence of endothelial dysfunction. Thus, changes in EVs cargo from selected cell sources in vivo may play causal roles in some of the adverse outcomes associated with OSA.
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Affiliation(s)
- David Sanz-Rubio
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
- Translational Research Unit, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IISAragón), 50009 Zaragoza, Spain;
| | - Abdelnaby Khalyfa
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
- Correspondence: ; Tel.: +1-573-884-7685
| | - Zhuanhong Qiao
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - Jorge Ullate
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - José M. Marin
- Translational Research Unit, Hospital Universitario Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IISAragón), 50009 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERes), 28029 Madrid, Spain
| | - Leila Kheirandish-Gozal
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
| | - David Gozal
- Department of Child Health, Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO 65201, USA; (D.S.-R.); (Z.Q.); (J.U.); (L.K.-G.); (D.G.)
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16
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Khor YH, Ng Y, Sweeney D, Ryerson CJ. Nocturnal hypoxaemia in interstitial lung disease: a systematic review. Thorax 2021; 76:1200-1208. [PMID: 33927018 DOI: 10.1136/thoraxjnl-2020-216749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with interstitial lung disease (ILD) are at risk of developing nocturnal hypoxaemia due to ventilatory restriction and impaired gas exchange that worsen with supine posture and reduced ventilatory drive during sleep. This systematic review synthesised literature on the diagnostic evaluation, epidemiology, associations, management and prognosis of nocturnal hypoxaemia in ILD. METHODS Ovid MEDLINE, Embase and CENTRAL databases were searched for eligible studies. Meta-analyses with subgroup analyses were conducted, where possible. RESULTS Fifty-three studies were included (total participant number=2590). The most common definition for clinically significant nocturnal hypoxaemia was ≥10% of total sleep time with oxyhaemoglobin saturation <90%, with pooled prevalence of 37%. There were no significant differences in pooled prevalence according to ILD subtype and comorbid obstructive sleep apnoea status. Study heterogeneity precluded meta-analysis of associations and prognosis. Diffusing capacity for carbon monoxide (DLCO) and echocardiographic features for pulmonary hypertension were consistently associated with nocturnal hypoxaemia. There were inconsistent associations between nocturnal hypoxaemia with ILD subtype and severity. Multivariable analyses in most studies demonstrated significant associations of nocturnal hypoxaemia with survival. Two small short-term intervention studies demonstrated that supplemental oxygen of 1-3 L/min corrected nocturnal hypoxaemia, with improved heart rate control during in-laboratory observation and increased serum antioxidant levels after 1 month of therapy. CONCLUSION Nocturnal hypoxaemia is common, associated with DLCO impairment and markers suggestive of pulmonary hypertension, and a potential prognostic factor in patients in ILD. There is a need to establish a consensus definition of nocturnal hypoxaemia and evaluate long-term effects of nocturnal supplemental oxygen in ILD.
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Affiliation(s)
- Yet Hong Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia .,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Yvonne Ng
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
| | - Duncan Sweeney
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Heart Lung Innovation, Providence Health Care, Vancouver, British Columbia, Canada
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Abstract
PURPOSE OF REVIEW In previous years, there was limited research related to the role of sleep in interstitial lung diseases (ILDs). Physicians treating ILD patients tended to focus mainly on the daily disabling symptoms overlooking the possible significant role of coexisting sleep disorders, such as obstructive sleep apnea (OSA). However, recently, there has been a growing interest in OSA in ILDs, as well as OSA effect on sleep, life quality and outcome in these patients with emphasis on idiopathic pulmonary fibrosis (IPF). RECENT FINDINGS OSA has been recognized as an important, high-prevalence comorbidity for the diagnosis and management of IPF. This publication provides a summary of the most relevant recent evidence with regard to OSA in various ILDs and especially IPF, including prevalence, clinical presentation, complications, screening and diagnosis. It also provides updated evidence on the role of OSA therapy in improving sleep, quality of life and disease outcome. SUMMARY It is too early to characterize OSA and ILDs association as an 'overlap' syndrome. In depth research is needed, including studies with large numbers of ILDs and IPF patients. The main priority is to increase the awareness among physicians for early diagnosis of OSA in ILDs patients.
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Li D, Wang B, Liu Y, Wang H. Prevalence and impact of comorbid obstructive sleep apnoea in diffuse parenchymal lung diseases. PLoS One 2021; 16:e0246878. [PMID: 33571266 PMCID: PMC7877600 DOI: 10.1371/journal.pone.0246878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/28/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Obstructive sleep apnea (OSA) are increasingly recognized as important features in diffuse parenchymal lung diseases (DPLDs) with differed prevalence and impact reported. The aim of this study is to systematically review the prevalence of comorbid OSA and characterize its impact on clinical and outcome measurements in adults with DPLDs. Methods Publications addressing the prevalence of OSA in DPLDs and its impacts on DPLDs were selected from electronic databases. A random-effect model was used to estimate the pooled prevalence of OSA. Odds ratios (ORs) or mean differences (MDs) were used to assess the associations of OSA with clinical and outcome measurements. Heterogeneity was quantified by I2 with 95% confidence interval (95% CI). Results 4 studies comprising 643 participants were included. Overall, the pooled prevalence of OSA among DPLDs was 72% (95% CI: 65–79%; I2 = 75.4%). Moderate-severe OSA was observed in 40% patients (95% CI: 28–52%; I2 = 90.8%). The prevalence was higher as 76% in idiopathic pulmonary fibrosis (IPF) patients than in connective tissue associated-ILD or sarcoidosis (60%). Although oxygen desaturation during sleep was greater in OSA group compared with non-OSA patients, there was no difference in lung function or systematic comorbidities between the two groups. The associations between OSA and the mortality or disease progression of DPLDs were also systematically reviewed. Conclusion In conclusion, OSA is a common comorbidity in DPLD patients, affecting approximately three in four patients, which may exacerbate the nocturnal desaturation and have negative influence on the outcomes. Larger studies with more homogeneous samples are warranted.
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Affiliation(s)
- Diandian Li
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bo Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- * E-mail:
| | - Yi Liu
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Haohua Wang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
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19
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Khor YH, Ryerson CJ, Landry SA, Howard ME, Churchward TJ, Edwards BA, Hamilton GS, Joosten SA. Interstitial lung disease and obstructive sleep apnea. Sleep Med Rev 2021; 58:101442. [PMID: 33561604 DOI: 10.1016/j.smrv.2021.101442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/30/2020] [Accepted: 10/29/2020] [Indexed: 12/11/2022]
Abstract
Obstructive sleep apnea (OSA) is one of the most common comorbidities in patients with interstitial lung disease (ILD). Growing evidence highlights the significance of sleep disturbance on health outcomes in this population. The relationships between ILD and OSA are complex and possibly bidirectional, with multiple mechanisms postulated for the pathogenic and physiologic links. This review synthesizes current evidence and hypotheses regarding different aspects of the relationships between ILD and OSA, emphasizing the interactions between epidemiology, pathogenesis, and pathophysiology.
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Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher J Ryerson
- Centre for Heart Lung Innovation, Providence Health Care, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shane A Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Mark E Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Thomas J Churchward
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Bradley A Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology, Monash University, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia
| | - Simon A Joosten
- Monash Lung and Sleep, Victoria, Australia; School of Clinical Sciences, Monash University, Victoria, Australia.
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20
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Khalyfa A, Ericsson A, Qiao Z, Almendros I, Farré R, Gozal D. Circulating exosomes and gut microbiome induced insulin resistance in mice exposed to intermittent hypoxia: Effects of physical activity. EBioMedicine 2021; 64:103208. [PMID: 33485839 PMCID: PMC7910674 DOI: 10.1016/j.ebiom.2021.103208] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/27/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background Gut microbiota (GM) contribute to obesity and insulin resistance (IR). Obstructive sleep apnea (OSA), characterized by intermittent hypoxia (IH), promotes IR and alters GM. Since circulating exosomes are implicated in IR, we examined the effects of IH and physical activity (PA) in mice on GM, colonic epithelium permeability, systemic IR, and plasma exosome cargo, and exosome effects on visceral white adipose tissues (vWAT) IR. Methods C57BL/6 mice were exposed to IH or room air (RA) for 6 weeks with and without PA (n = 12/group), and GM and systemic IR changes were assessed, as well as the effects of plasma exosomes on naïve adipocyte insulin sensitivity. Fecal microbiota transfers (FMT) were performed in naïve mice (n = 5/group), followed by fecal 16S rRNA sequencing, and systemic IR and exosome-induced effects on adipocyte insulin sensitivity were evaluated. Findings Principal coordinate analysis (PCoA) ordinates revealed B-diversity among IH and FMT recipients that accounted for 64% principal component 1 (PC1) and 12.5% (PC2) of total variance. Dominant microbiota families and genera in IH-exposed and FMT-treated were preserved, and IH-exposed GM and IH-FMT induced increased gut permeability. Plasma exosomes from IH-exposed and IH-FMT mice decreased pAKT/AKT responses to exogenous insulin in adipocytes vs. IH+PA or RA FMT-treated mice (p = 0.001). Interpretation IH exposures mimicking OSA induce changes in GM, increase gut permeability, and alter plasma exosome cargo, the latter inducing adipocyte dysfunction (increased IR). Furthermore, these alterations improved with PA. Thus, IH leads to perturbations of a singular GM-circulating exosome pathway that disrupts adipocyte homeostasis resulting in metabolic dysfunction, as reflected by IR. Funding This study was supported by grants from the National Institutes of Health grants HL130984 and HL140548 and University of Missouri Tier 2 grant. The study has not received any funding or grants from pharmaceutical or other industrial corporations.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Child Health and the Child Health Research Institute, University of Missouri, School of Medicine, Columbia, 400N. Keene Street, Suite 010, MO 65201, United States.
| | - Aaron Ericsson
- University of Missouri Metagenomics Center, Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri at Columbia, Columbia, MO 65201, United States
| | - Zhuanghong Qiao
- Department of Child Health and the Child Health Research Institute, University of Missouri, School of Medicine, Columbia, 400N. Keene Street, Suite 010, MO 65201, United States
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
| | - Ramon Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Institut d'Investigacions Biomediques August Pi Sunyer, Barcelona, Spain
| | - David Gozal
- Department of Child Health and the Child Health Research Institute, University of Missouri, School of Medicine, Columbia, 400N. Keene Street, Suite 010, MO 65201, United States.
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21
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Vahedi E, Khosravi A, Alizadian R, Badri T. Cardiac function and cognitive function in patients with obstructive sleep apnea. SLEEP SCIENCE AND PRACTICE 2021. [DOI: 10.1186/s41606-020-00055-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objectives
This study was designed to evaluate echocardiographic findings in patients with obstructive sleep apnea (OSA) with cognitive impairment and compare it with the control group.
Methods
Sixty-seven OSA patients and 52 group of healthy controls were evaluated prospectively by Mini-Mental State Examination questionnaire and trans-thoracic echocardiography.
Results
The cognitive impairment and diastolic dysfunction were 19.6% (P = .002) and 18.4% (P = .016) more prevalent in OSA group compared to the control group. The mean tricuspid regurgitant gradient, pulmonary artery size, and transmitral A velocity were higher, but mean right ventricular peak systolic velocity, tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), transmitral E/A ratio, and annular E’ velocity were lower in the OSA group than the control group. Comparing the patients with and without cognitive disorders, showed significant differences regarding the size of right atrium, TAPSE and FAC (P < .05).
Conclusions
OSA patients need accurate cardiac examinations, early diagnosis, and interventions to prevent the progression of cardiac dysfunction, especially older male patients with higher BMI and impaired cognition. Further studies are needed to determine the exact link between the OSA, obesity, and cardiac physiology.
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22
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TRĂILĂ D, PESCARU C, SUPPINI POROJAN N, MIHUTA C, HOGEA P, CRIŞAN A, CIUMARNEAN L, MARC Monica. Neuromuscular electrostimulation as an adjuvant therapy to pulmonary rehabilitation programs in chronic obstructive pulmonary disease. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Chronic obstructive pulmonary disease (COPD) is commonly associated with a vicious circle of sedentary lifestyle - deconditioning - muscular dysfunction. High-frequency neuromuscular electrostimulation has demonstrated beneficial effects among subjects with muscle weakness. This study aimed to evaluate the benefits of merging pulmonary rehabilitation program (PRP) with neuromuscular electrostimulation in patients with very severe COPD. Material and methods. The study included 38 males with clinically stable COPD, who were divided in 2 groups: group A-19 patients that underwent a PRP of 5 sessions/week for 4 weeks and group B-19 patients that underwent intercostal and lower extremity muscle electrostimulation (5 sessions/week for 4 weeks, 60 min /session) in association with the same type of PRP. Saint Georges’s Respiratory Questionnaire (SGRQ), Modified Medical Research Council (mMRC) dyspnea scale, spirometry, maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax), six minutes walking test (6MWT) and bio-electrical impedance were examined before and after the intervention. Results. Electrostimulation applied in group B increased muscle mass (50.15 ± 0.61kg vs 53.97 ± 0.87kg, p<0.001)., PEmax (5.41 ± 0.25 vs post 6.79 ± 0.22, p<0.0003) and improved mMRC score (2.68 ± 0.15 vs 2.10 ± 0.15, p<0.0109), 6MWT (369.6 ± 10.77m vs post: 445.6 ± 6.03 m) and SGRQ (61.32 ± 1.83 vs. 44.95 ± 1.94, p<0.0001). In group B only SGRQ score (55.05 ± 1.32 vs. 50.05 ± 1.51, p=0.018) was improved after PRP. Conclusion. A protocol which combines PRP with neuromuscular electrical stimulation in patients with very severe forms of COPD, has grater beneficial effect on dyspnoea, exercise tolerance, muscle mass toning and quality of life, compared with PRP alone.
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Affiliation(s)
- Daniel TRĂILĂ
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Camelia PESCARU
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | | | - Camil MIHUTA
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Patricia HOGEA
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Alexandru CRIŞAN
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Lorena CIUMARNEAN
- ”Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - MARC Monica
- “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
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23
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Lian N, Zhang S, Huang J, Lin T, Lin Q. Resveratrol Attenuates Intermittent Hypoxia-Induced Lung Injury by Activating the Nrf2/ARE Pathway. Lung 2020; 198:323-331. [DOI: 10.1007/s00408-020-00321-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/02/2020] [Indexed: 12/22/2022]
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