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Sleep Apnea Syndromes: HELP
Articles by Ferrán Barbe
Based on 87 articles published since 2008
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Between 2008 and 2019, F. Barbe wrote the following 87 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
1 Editorial [Personalized medicine in sleep apnea: Towards a new paradigm of comprehensive disease management]. 2016

Sánchez-de-la-Torre, Manuel / Barbé, Ferran. ·Departamento de Respiratorio, Hospital Universitari Arnau de Vilanova y Santa Maria, Institut de Recerca Biomèdica de Lleida (IRB Lleida), Universidad de Lleida, Lleida, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España. ·Med Clin (Barc) · Pubmed #27751511.

ABSTRACT: -- No abstract --

2 Editorial Gamma glutamyl transferase in 1744 patients with obstructive sleep apnea. 2016

Sánchez-Armengol, A / Villalobos-López, P / Caballero-Eraso, C / Carmona-Bernal, C / Asensio-Cruz, M / Barbé, F / Capote, F. ·Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocío University Hospital, Calle Águilas n 16 casa 1, Mairena del Aljarafe, Sevilla, 41003, Spain. · Biomedical Research Institute, Sevilla, Spain. · Torrecárdenas Hospital, Almería, Spain. · Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocío University Hospital, Calle Águilas n 16 casa 1, Mairena del Aljarafe, Sevilla, 41003, Spain. ccaballero-ibis@us.es. · Biomedical Research Institute, Sevilla, Spain. ccaballero-ibis@us.es. · Respiratory Department, Arnau de Vilanova Hospital, Lleida, Spain. · CIBERes (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias), Mallorca, Spain. ·Sleep Breath · Pubmed #26156888.

ABSTRACT: -- No abstract --

3 Editorial Hypoglossal neurostimulation for obstructive sleep apnoea. 2013

Barbé, Ferran / Masa, Juan F. · ·Eur Respir J · Pubmed #23370799.

ABSTRACT: -- No abstract --

4 Editorial Does minimally symptomatic sleep apnea constitute a cardiovascular risk factor? 2011

Mediano, Olga / Barbé, Ferran. · ·Arch Bronconeumol · Pubmed #21190769.

ABSTRACT: -- No abstract --

5 Review Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. 2017

Drager, Luciano F / McEvoy, R Doug / Barbe, Ferran / Lorenzi-Filho, Geraldo / Redline, Susan / Anonymous1150926. ·From Hypertension Unit (L.F.D.) and Sleep Laboratory, Pulmonary Division (G.L.-F.), Instituto do Coracao, and Hypertension Unit, Renal Division (L.F.D.), University of São Paulo Medical School, Brazil · Adelaide Institute for Sleep Health, College of Medicine and Public Health, and School of Medicine, Faculty of Medicine, Nursing, and Health Sciences, Flinders University, Australia (R.D.M.) · Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Australia (R.D.M.) · Respiratory Department, Institut de Recerca Biomèdica de Lleida, Lleida and Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain (F.B.) · and Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (S.R.). ·Circulation · Pubmed #29109195.

ABSTRACT: Emerging research highlights the complex interrelationships between sleep-disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patients presenting to cardiology clinics have a high prevalence of obstructive and central sleep apnea associated with Cheyne-Stokes respiration. Multiple mechanisms have been identified by which sleep disturbances adversely affect cardiovascular structure and function. Epidemiological research indicates that obstructive sleep apnea is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke, and atrial fibrillation. Central sleep apnea associated with Cheyne-Stokes respiration predicts incident heart failure and atrial fibrillation; among patients with heart failure, it strongly predicts mortality. Thus, a strong literature provides the mechanistic and empirical bases for considering obstructive sleep apnea and central sleep apnea associated with Cheyne-Stokes respiration as potentially modifiable risk factors for cardiovascular disease. Data from small trials provide evidence that treatment of obstructive sleep apnea with continuous positive airway pressure improves not only patient-reported outcomes such as sleepiness, quality of life, and mood but also intermediate cardiovascular end points such as blood pressure, cardiac ejection fraction, vascular parameters, and arrhythmias. However, data from large-scale randomized controlled trials do not currently support a role for positive pressure therapies for reducing cardiovascular mortality. The results of 2 recent large randomized controlled trials, published in 2015 and 2016, raise questions about the effectiveness of pressure therapies in reducing clinical end points, although 1 trial supported the beneficial effect of continuous positive airway pressure on quality of life, mood, and work absenteeism. This review provides a contextual framework for interpreting the results of recent studies, key clinical messages, and suggestions for future sleep and cardiovascular research, which include further consideration of individual risk factors, use of existing and new multimodality therapies that also address adherence, and implementation of trials that are sufficiently powered to target end points and to support subgroup analyses. These goals may best be addressed through strengthening collaboration among the cardiology, sleep medicine, and clinical trial communities.

6 Review Pulmonary Function and Sleep Breathing: Two New Targets for Type 2 Diabetes Care. 2017

Lecube, Albert / Simó, Rafael / Pallayova, Maria / Punjabi, Naresh M / López-Cano, Carolina / Turino, Cecilia / Hernández, Cristina / Barbé, Ferran. ·Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain. · Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain. · Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Spain. · Department of Medicine, Weill Cornell Medicine. · Department of Human Physiology and Sleep Laboratory, Faculty of Medicine, Pavol Jozef Šafárik University, Slovak Republic. · Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University. · Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University. · Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, Institut de Recerca Biomédica de Lleida, Universitat de Lleida, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Spain. ·Endocr Rev · Pubmed #28938479.

ABSTRACT: Population-based studies showing the negative impact of type 2 diabetes (T2D) on lung function are overviewed. Among the well-recognized pathophysiological mechanisms, the metabolic pathways related to insulin resistance (IR), low-grade chronic inflammation, leptin resistance, microvascular damage, and autonomic neuropathy are emphasized. Histopathological changes are exposed, and findings reported from experimental models are clearly differentiated from those described in humans. The accelerated decline in pulmonary function that appears in patients with cystic fibrosis (CF) with related abnormalities of glucose tolerance and diabetes is considered as an example to further investigate the relationship between T2D and the lung. Furthermore, a possible causal link between antihyperglycemic therapies and pulmonary function is examined. T2D similarly affects breathing during sleep, becoming an independent risk factor for higher rates of sleep apnea, leading to nocturnal hypoxemia and daytime sleepiness. Therefore, the impact of T2D on sleep breathing and its influence on sleep architecture is analyzed. Finally, the effect of improving some pathophysiological mechanisms, primarily IR and inflammation, as well as the optimization of blood glucose control on sleep breathing is evaluated. In summary, the lung should be considered by those providing care for people with diabetes and raise the central issue of whether the normalization of glucose levels can improve pulmonary function and ameliorate sleep-disordered breathing. Therefore, patients with T2D should be considered a vulnerable group for pulmonary dysfunction. However, further research aimed at elucidating how to screen for the lung impairment in the population with diabetes in a cost-effective manner is needed.

7 Review Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. 2017

Javaheri, Shahrokh / Barbe, Ferran / Campos-Rodriguez, Francisco / Dempsey, Jerome A / Khayat, Rami / Javaheri, Sogol / Malhotra, Atul / Martinez-Garcia, Miguel A / Mehra, Reena / Pack, Allan I / Polotsky, Vsevolod Y / Redline, Susan / Somers, Virend K. ·Pulmonary and Sleep Division, Bethesda North Hospital, Cincinnati, Ohio. Electronic address: shahrokhjavaheri@icloud.com. · Respiratory Department, Institut Ricerca Biomèdica de Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain. · Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain. · Department of Population Health Sciences and John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin-Madison, Madison, Wisconsin. · Sleep Heart Program, the Ohio State University, Columbus, Ohio. · Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts. · Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego, California. · Respiratory Department, Hospital Universitario de Politecnico La Fe, Valencia, Spain. · Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio. · Division of Sleep Medicine/Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. · Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. · Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts. · Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. ·J Am Coll Cardiol · Pubmed #28209226.

ABSTRACT: Sleep apnea is highly prevalent in patients with cardiovascular disease. These disordered breathing events are associated with a profile of perturbations that include intermittent hypoxia, oxidative stress, sympathetic activation, and endothelial dysfunction, all of which are critical mediators of cardiovascular disease. Evidence supports a causal association of sleep apnea with the incidence and morbidity of hypertension, coronary heart disease, arrhythmia, heart failure, and stroke. Several discoveries in the pathogenesis, along with developments in the treatment of sleep apnea, have accumulated in recent years. In this review, we discuss the mechanisms of sleep apnea, the evidence that addresses the links between sleep apnea and cardiovascular disease, and research that has addressed the effect of sleep apnea treatment on cardiovascular disease and clinical endpoints. Finally, we review the recent development in sleep apnea treatment options, with special consideration of treating patients with heart disease. Future directions for selective areas are suggested.

8 Review Cancer and OSA: Current Evidence From Human Studies. 2016

Martínez-García, Miguel Ángel / Campos-Rodriguez, Francisco / Barbé, Ferrán. ·Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain. Electronic address: mianmartinezgarcia@gmail.com. · Respiratory Department, Hospital Universitario Valme, Seville, Spain. · Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain. ·Chest · Pubmed #27164292.

ABSTRACT: Despite the undeniable medical advances achieved in recent decades, cancer remains one of the main causes of mortality. It is thus extremely important to make every effort to discover new risk factors for this disease, particularly ones that can be treated or modified. Various pathophysiologic pathways have been postulated as possible causes of cancer or its increased aggressiveness, and also of greater resistance to antitumoral treatment, in the presence of both intermittent hypoxia and sleep fragmentation (both inherent to sleep apnea). Thus far, these biological hypotheses have been supported by various experimental studies in animals. Meanwhile, recent human studies drawing on preexisting databases have observed an increase in cancer incidence and mortality in patients with a greater severity of sleep-disordered breathing. However, the methodologic limitations of these studies (which are mostly retrospective and lack any measurement of direct markers of intermittent hypoxia or sleep fragmentation) highlight the need for controlled, prospective studies that would provide stronger scientific evidence regarding the existence of this association and its main characteristics, as well as explore its nature and origin in greater depth. The great epidemiologic impact of both cancer and sleep apnea and the potential for clinical treatment make this field of research an exciting challenge.

9 Review Obstructive sleep apnoea syndrome. 2015

Lévy, Patrick / Kohler, Malcolm / McNicholas, Walter T / Barbé, Ferran / McEvoy, R Doug / Somers, Virend K / Lavie, Lena / Pépin, Jean-Louis. ·Grenoble University Hospital, Department of Physiology, Sleep Laboratory, BP 53, 38041 Grenoble, Cedex 9, France. · Hypoxia-Pathophysiology Laboratory (HP2), University Grenoble Alpes, Grenoble, France. · Department of Pulmonology, University Hospital of Zurich, Zurich, Switzerland. · Pulmonary and Sleep Disorders Unit, University College Dublin, Dublin, Ireland. · Respiratory Department, Arnau de Vilanova and Santa Maria University Hospital, Leida, Spain. · Respiratory Research Group, CIBERES, Madrid, Spain. · Adelaide Institute for Sleep Health, Adelaide, Australia. · Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. · The Rappaport Faculty of Medicine, Unit of Anatomy and Cell Biology, Technion - Israel Institute of Technology, Haifa, Israel. ·Nat Rev Dis Primers · Pubmed #27188535.

ABSTRACT: Obstructive sleep apnoea syndrome (OSAS) is a common clinical condition in which the throat narrows or collapses repeatedly during sleep, causing obstructive sleep apnoea events. The syndrome is particularly prevalent in middle-aged and older adults. The mechanism by which the upper airway collapses is not fully understood but is multifactorial and includes obesity, craniofacial changes, alteration in upper airway muscle function, pharyngeal neuropathy and fluid shift towards the neck. The direct consequences of the collapse are intermittent hypoxia and hypercapnia, recurrent arousals and increase in respiratory efforts, leading to secondary sympathetic activation, oxidative stress and systemic inflammation. Excessive daytime sleepiness is a burden for the majority of patients. OSAS is also associated with cardiovascular co-morbidities, including hypertension, arrhythmias, stroke, coronary heart disease, atherosclerosis and overall increased cardiovascular mortality, as well as metabolic dysfunction. Whether treating sleep apnoea can fully reverse its chronic consequences remains to be established in adequately designed studies. Continuous positive airway pressure (CPAP) is the primary treatment modality in patients with severe OSAS, whereas oral appliances are also widely used in mild to moderate forms. Finally, combining different treatment modalities such as CPAP and weight control is beneficial, but need to be evaluated in randomized controlled trials. For an illustrated summary of this Primer, visit: http://go.nature.com/Lwc6te.

10 Review Relationship Between OSA and Hypertension. 2015

Torres, Gerard / Sánchez-de-la-Torre, Manuel / Barbé, Ferran. ·From the Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Catalonia. · From the Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Catalonia; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · From the Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Catalonia; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.. Electronic address: febarbe.lleida.ics@gencat.cat. ·Chest · Pubmed #25879807.

ABSTRACT: There is a bidirectional association between OSA and systemic hypertension. The strengths of this relationship appear to be modulated by factors such as age, sex, and somnolence. The 24-h BP circadian pattern also appears to be influenced by OSA. Patients with this syndrome exhibit a high prevalence of nondipping or riser circadian patterns, which are related to clinical and subclinical organ damage in the heart and brain. However, the influence of OSA on nocturnal hypertension development has not yet been clarified. A special area of interest is the recognized relationship between OSA and resistant hypertension. The majority of patients with resistant hypertension suffer OSA. CPAP treatment significantly reduces BP in such patients and could play a clinical role in the management of BP in these patients. Several meta-analyses have demonstrated a concordant mild effect of CPAP on systemic hypertension. This effect is related to CPAP compliance, somnolence status, and baseline BP. The effects of oral appliances on BP in patients with OSA must be evaluated in randomized controlled trials. In the absence of additional data reported by clinical studies on other antihypertensive drug treatments, diuretics, particularly antialdosteronic diuretic agents, should be considered the first-line antihypertensive drug treatment in patients with OSA. By reducing parapharyngeal edema and secondary upper airway obstruction, these drugs appear to improve OSA severity and also to reduce BP.

11 Review Obstructive sleep apnoea and cardiovascular disease. 2013

Sánchez-de-la-Torre, Manuel / Campos-Rodriguez, Francisco / Barbé, Ferran. ·Respiratory Department, Hospital Universitari Arnau de Vilanova-Santa María, IRB Lleida, Lleida, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. ·Lancet Respir Med · Pubmed #24321805.

ABSTRACT: Obstructive sleep apnoea (OSA) is a common health concern caused by repeated episodes of collapse of the upper airway during sleep. The events associated with OSA lead to brain arousal, intrathoracic pressure changes, and intermittent episodes of hypoxaemia and reoxygenation. These events activate pathways such as oxidative stress, sympathetic activation, inflammation, hypercoagulability, endothelial dysfunction, and metabolic dysregulation that predispose patients with OSA to hypertension and atherosclerosis. OSA is a common cause of systemic hypertension and should be suspected in hypertensive individuals, especially those with resistant hypertension. In patients with OSA, continuous positive airway pressure (CPAP) treatment reduces blood pressure, and its effects are related to compliance and baseline blood pressure. Evidence suggests that OSA is a risk factor for stroke and heart failure. An association between coronary heart disease and OSA seems to be limited to middle-aged men (30-70 years). Cardiac rhythm disorders occur in about half of patients with OSA, but their clinical relevance is still unknown. The association of OSA with cardiovascular risk is mainly based on studies in men, and an association has yet to be established in women. Data on older patients is similarly scarce. Currently, there is not enough evidence to support treatment with CPAP for primary or secondary prevention of cardiovascular disease.

12 Review Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome. 2013

Corral-Peñafiel, Jaime / Pepin, Jean-Louis / Barbe, Ferran. ·Respiratory Dept, San Pedro de Alcántara Hospital, CIBER de enfermedades respiratorias, Madrid. jcorral@separ.es ·Eur Respir Rev · Pubmed #23997059.

ABSTRACT: Obstructive sleep apnoea (OSA) is a highly prevalent disorder associated with complications such as arterial hypertension, cardiovascular diseases and traffic accidents. The resources allocated for OSA are insufficient and OSA is a significant public health problem. Portable recording devices have been developed for the detection of OSA syndrome and have proved capable of providing an equivalent diagnosis to in-laboratory polysomnography (PSG), at least in patients with a high pre-test probability of OSA syndrome. PSG becomes important in patients who have symptoms and certain comorbidities such as chronic obstructive pulmonary disease or stroke, as well as in patients with a clinical history suggesting a different sleep disorder. Continuous positive airway pressure is the most effective treatment in OSA. Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared to the conventional approach, without sacrificing efficiency. This review evaluates the role of portable monitoring devices in the diagnostic process of OSA and the search for alternative strategies based on ambulatory management protocols.

13 Review The use of ambulatory strategies for the diagnosis and treatment of obstructive sleep apnea in adults. 2013

Chiner, Eusebi / Andreu, Ada L / Sancho-Chust, Jose N / Sánchez-de-la-Torre, Alicia / Barbé, Ferran. ·Pulmonology Section, University Hospital of Sant Joan d'Alacant, Sant Joan d'Alacant, Spain. ·Expert Rev Respir Med · Pubmed #23734648.

ABSTRACT: Obstructive sleep apnea (OSA) is a highly prevalent disorder associated with complications such as arterial hypertension, coronary heart disease, cerebrovascular disease and traffic accidents. Patients with untreated OSA consume more financial and healthcare resources and have higher mortality than those treated properly. The resources allocated for OSA are insufficient in some countries for such a prevalent disorder. This has given rise to a significant public health problem and a search for alternative strategies based on the ambulatory management. In the diagnostic process, portable monitors have been evaluated. Continuous positive airway pressure is the most effective treatment in OSA, but other forms of treatments have also been used (weight loss, oral appliances, surgery and so on). Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared with the conventional approach, without sacrificing efficiency. This review aims to highlight the most important advances in this field, analyzing the results of the main works to date, in order to assess the current situation and future research needs.

14 Clinical Trial Predictors of obstructive sleep apnoea in patients admitted for acute coronary syndrome. 2017

de Batlle, Jordi / Turino, Cecilia / Sánchez-de-la-Torre, Alicia / Abad, Jorge / Duran-Cantolla, Joaquín / McEvoy, R Douglas / Antic, Nick A / Mediano, Olga / Cabriada, Valentín / Masdeu, Maria José / Teran, Joaquín / Valls, Joan / Barbé, Ferran / Sánchez-de-la-Torre, Manuel / Anonymous6660899. ·Respiratory Dept, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain. · Both authors contributed equally to this study. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · Respiratory Dept, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. · Medicine Dept, OSI Araba University Hospital, UPV, BioAraba Institute, Vitoria, Spain. · Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Adelaide, Australia. · Respiratory Dept, Hospital Universitario de Guadalajara, Guadalajara, Spain. · Respiratory Dept, Hospital de Cruces, Bilbao, Spain. · Respiratory Dept, Hospital Parc Taulí, Sabadell, Spain. · Respiratory Dept, Hospital General Yagüe, Burgos, Spain. · Unit of Bioestatistics and Epidemiology, IRBLleida, Lleida, Spain. · Respiratory Dept, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain sanchezdelatorre@gmail.com. ·Eur Respir J · Pubmed #28298397.

ABSTRACT: Identifying undiagnosed obstructive sleep apnoea (OSA) patients in cardiovascular clinics could improve their management. Aiming to build an OSA predictive model, a broad analysis of clinical variables was performed in a cohort of acute coronary syndrome (ACS) patients.Sociodemographic, anthropometric, life-style and pharmacological variables were recorded. Clinical measures included blood pressure, electrocardiography, echocardiography, blood count, troponin levels and a metabolic panel. OSA was diagnosed using respiratory polygraphy. Logistic regression models and classification and regression trees were used to create predictive models.A total of 978 patients were included (298 subjects with apnoea-hypopnoea index (AHI) <15 events·h

15 Clinical Trial Effects of Ethnicity on the Prevalence of Obstructive Sleep Apnoea in Patients with Acute Coronary Syndrome: A Pooled Analysis of the ISAACC Trial and Sleep and Stent Study. 2017

Koo, Chieh-Yang / de la Torre, Alicia Sánchez / Loo, Germaine / Torre, Manuel Sánchez-de-la / Zhang, Junjie / Duran-Cantolla, Joaquin / Li, Ruogu / Mayos, Mercé / Sethi, Rishi / Abad, Jorge / Furlan, Sofia F / Coloma, Ramón / Hein, Thet / Ho, Hee-Hwa / Jim, Man-Hong / Ong, Thun-How / Tai, Bee-Choo / Turino, Cecilia / Drager, Luciano F / Lee, Chi-Hang / Barbe, Ferran. ·Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore. Electronic address: christopher_koo@nuhs.edu.sg. · Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore. · Department of Cardiology, Nanjing First Hospital, Nanjing, China. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Bio-Araba Research Institute, Araba University Hospital, Department of Medicine of Basque Country University, Vitoria-Gasteiz, Spain. · Department of Cardiology, Shanghai Chest Hospital, Shanghai, China. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Sleep Unit, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. · Department of Cardiology, King George's Medical University, Lucknow, India. · Respiratory Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Catalonia, Spain. · Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil. · Respiratory Department, Hospital General Universitario de Albacete, Spain. · No (1) 1000 bedded Defence Services General Hospital, Mingaladon, Yangon, Myanmar. · Department of Cardiology, Tan Tock Seng Hospital, Singapore. · Cardiac Medical Unit, The Grantham Hospital, Hong Kong. · Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore. · Saw Swee Hock School of Public Health, National University of Singapore, Singapore. · Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain. · Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. Electronic address: febarbe.lleida.ics@gencat.cat. ·Heart Lung Circ · Pubmed #27939743.

ABSTRACT: BACKGROUND: Obstructive sleep apnoea (OSA) is an emerging risk factor for acute coronary syndrome (ACS). We sought to determine the effects of ethnicity on the prevalence of OSA in patients presenting with ACS who participated in an overnight sleep study. METHODS: A pooled analysis using patient-level data from the ISAACC Trial and Sleep and Stent Study was performed. Using the same portable diagnostic device, OSA was defined as an apnoea-hypopnoea index of ≥15 events per hour. RESULTS: A total of 1961 patients were analysed, including Spanish (53.6%, n=1050), Chinese (25.5%, n=500), Indian (12.0%, n=235), Malay (6.1%, n=119), Brazilian (1.7%, n=34) and Burmese (1.2%, n=23) populations. Significant differences in body mass index (BMI) were found among the various ethnic groups, averaging from 25.3kg/m CONCLUSION: There was significant ethnic variation in the prevalence of OSA in patients with ACS. The magnitude of the effect of BMI on OSA was greater in the Chinese population than in the Spanish patients.

16 Article Long-term clinical effectiveness of continuous positive airway pressure therapy versus non-invasive ventilation therapy in patients with obesity hypoventilation syndrome: a multicentre, open-label, randomised controlled trial. 2019

Masa, Juan F / Mokhlesi, Babak / Benítez, Iván / Gomez de Terreros, Francisco Javier / Sánchez-Quiroga, Maria Ángeles / Romero, Auxiliadora / Caballero-Eraso, Candela / Terán-Santos, Joaquin / Alonso-Álvarez, Maria Luz / Troncoso, Maria F / González, Mónica / López-Martín, Soledad / Marin, José M / Martí, Sergi / Díaz-Cambriles, Trinidad / Chiner, Eusebi / Egea, Carlos / Barca, Javier / Vázquez-Polo, Francisco-José / Negrín, Miguel A / Martel-Escobar, María / Barbe, Ferran / Corral, Jaime / Anonymous1421199. ·Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. Electronic address: fmasa@separ.es. · Department of Medicine, University of Chicago, Chicago, IL, USA. · Respiratory Department, Institut de Recerca Biomédica de LLeida (IRBLLEIDA), Lleida, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Respiratory Department, San Pedro de Alcántara Hospital, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. · Respiratory Department, Virgen del Puerto Hospital, Plasencia, Cáceres, Spain; CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, University Hospital, Burgos, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, IIS Fundación Jiménez Díaz, Madrid, Spain. · Respiratory Department, Valdecilla Hospital, Santander, Spain. · Respiratory Department, Gregorio Marañon Hospital, Madrid, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Miguel Servet Hospital, Zaragoza, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Valld'Hebron Hospital, Barcelona, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Doce de Octubre Hospital, Madrid, Spain. · Respiratory Department, San Juan Hospital, Alicante, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain; Respiratory Department, Alava University Hospital IRB, Vitoria, Spain. · Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain; Nursing Department, Extremadura University, Cáceres, Spain. · Department of Quantitative Methods, Las Palmas de Gran Canarias University Canary Islands, Spain. ·Lancet · Pubmed #30935737.

ABSTRACT: BACKGROUND: Obesity hypoventilation syndrome is commonly treated with continuous positive airway pressure or non-invasive ventilation during sleep. Non-invasive ventilation is more complex and costly than continuous positive airway pressure but might be advantageous because it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. We therefore aimed to determine the long-term comparative effectiveness of both treatment modalities. METHODS: We did a multicentre, open-label, randomised controlled trial at 16 clinical sites in Spain. We included patients aged 15-80 years with untreated obesity hypoventilation syndrome and an apnoea-hypopnoea index of 30 or more events per h. We randomly assigned patients, using simple randomisation through an electronic database, to receive treatment with either non-invasive ventilation or continuous positive airway pressure. Both investigators and patients were aware of the treatment allocation. The research team was not involved in deciding hospital treatment, duration of treatment in the hospital, and adjustment of medications, as well as adjudicating cardiovascular events or cause of mortality. Treating clinicians from the routine care team were not aware of the treatment allocation. The primary outcome was the number of hospitalisation days per year. The analysis was done according to the intention-to-treat principle. This study is registered with ClinicalTrials.gov, number NCT01405976. FINDINGS: From May 4, 2009, to March 25, 2013, 100 patients were randomly assigned to the non-invasive ventilation group and 115 to the continuous positive airway pressure group, of which 97 patients in the non-invasive ventilation group and 107 in the continuous positive airway pressure group were included in the analysis. The median follow-up was 5·44 years (IQR 4·45-6·37) for all patients, 5·37 years (4·36-6·32) in the continuous positive airway pressure group, and 5·55 years (4·53-6·50) in the non-invasive ventilation group. The mean hospitalisation days per patient-year were 1·63 (SD 3·74) in the continuous positive airway pressure group and 1·44 (3·07) in the non-invasive ventilation group (adjusted rate ratio 0·78, 95% CI 0·34-1·77; p=0·561). Adverse events were similar between both groups. INTERPRETATION: In stable patients with obesity hypoventilation syndrome and severe obstructive sleep apnoea, non-invasive ventilation and continuous positive airway pressure have similar long-term effectiveness. Given that continuous positive airway pressure has lower complexity and cost, continuous positive airway pressure might be the preferred first-line positive airway pressure treatment modality until more studies become available. FUNDING: Instituto de Salud Carlos III, Spanish Respiratory Foundation, and Air Liquide Spain.

17 Article Beyond Resistant Hypertension. 2018

Martínez-García, Miguel-Angel / Navarro-Soriano, Cristina / Torres, Gerard / Barbé, Ferrán / Caballero-Eraso, Candela / Lloberes, Patricia / Diaz-Cambriles, Teresa / Somoza, María / Masa, Juan F / González, Mónica / Mañas, Eva / de la Peña, Mónica / García-Río, Francisco / Montserrat, Josep María / Muriel, Alfonso / Selma-Ferrer, Maria Jose / García Ortega, Alberto / Campos-Rodriguez, Francisco / Anonymous2311118. ·From the Department of Pneumology, Hospital Universitario y Politécnico La Fe, Valencia, Spain (M.-A.M.-G., C.N.-S., M.J.S.-F., A.G.O.). · Internal Medicine Service, Hospital Universitari de Santa María, Lleida, Spain (G.T.). · Institut de Recerca Biomédica, IRB Lleida, Spain (F.B.). · CIBERes (Centro de Investigación en red de enfermedades respiratorias), CIBER de enfermedades Respiratorias, Madrid, Spain (F.B., F.G.-R., J.M.M.). · Respiratory Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain (C.C.-E.). · Respiratory Department, Hospital Universitario Vall Hebrón, Barcelona, Spain (P.L.). · Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain (T.D.-C.). · Respiratory Department, Consorcio Sanitario de Terrassa, Barcelona, Spain (M.S.). · Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain (J.F.M.). · Respiratory Department, Hospital Universitario Marqués de Valdecilla, IDIVAL (Instituto de Investigación Valdecilla), Santander, Spain (M.G.). · Respiratory Department (E.M.). · Respiratory Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain (M.d.l.P.). · Respiratory Department, Hospital Universitario La Paz, IdiPAZ (Instituto de Investigaciòn Hospital La paz), Madrid, Spain (F.G.-R.). · Respiratory Department, Hospital Clinic-IDIBAPS (Instituto de Investigación Biomédicas August Pi i Sunyer), Barcelona, Spain (J.M.M.). · Biostatistic Department (A.M.), Hospital Universitario Ramón y Cajal, Madrid, Spain. · Respiratory Department, Hospital Universitario Valme, Sevilla, Spain (F.C.-R.). ·Hypertension · Pubmed #30354751.

ABSTRACT: Obstructive sleep apnea (OSA) is an independent cause of resistant hypertension (RH) but its association with refractory hypertension (RfH), a recently described form of severe hypertension, has not yet been investigated. This study seeks to analyze the association between the presence and severity of OSA/OSA syndrome with RfH and to compare it with a group of patients with OSA/OSA syndrome and RH. We conducted a multicenter, cross-sectional study of consecutive patients diagnosed with RH by means of 24-hour ambulatory blood pressure monitoring. Those patients with blood pressure levels ≥130/80 mm Hg, despite taking at least 5 antihypertensive drugs, were considered to have true RfH. All patients underwent a sleep study and completed a detailed clinical history related to OSA, current medication, and cardiovascular diseases. Overall, 229 patients were included (mean age, 58.3 years; 63% male), of whom 42 (18.3%) satisfied the criteria for RfH. Compared with those with RH, patients with RfH had a higher cardiovascular risk profile, higher blood pressure measurements, and a 2-fold greater risk of having both severe OSA (odds ratio, 2.1, with a prevalence of apnea-hypopnea index ≥15, 95.2% and apnea-hypopnea index ≥30, 64.3%) and OSA syndrome (apnea-hypopnea index ≥5+Epworth Sleepiness Scale >10; odds ratio, 1.9; 52.4% versus 37.3%; P=0.023), as well as higher OSA severity (apnea-hypopnea index, 41.8 versus 33.8 events/h; P=0.026). Patients with RfH had an even greater prevalence and severity of OSA and OSA syndrome than RH patients, highlighting the need to identify these patients to refer them to sleep units on a preferential basis.

18 Article Erectile dysfunction in obstructive sleep apnea patients: A randomized trial on the effects of Continuous Positive Airway Pressure (CPAP). 2018

Pascual, Mercè / de Batlle, Jordi / Barbé, Ferran / Castro-Grattoni, Anabel L / Auguet, Josep M / Pascual, Lydia / Vilà, Manel / Cortijo, Anunciación / Sánchez-de-la-Torre, Manuel. ·Urology Department, Hospital Universitari Santa Maria, Lleida, Spain. · Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLLEIDA, Lleida, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. ·PLoS One · Pubmed #30089160.

ABSTRACT: OBJECTIVES: Obstructive sleep apnea (OSA) is among the least studied risk factors for erectile dysfunction (ED). We aimed to determine ED prevalence in newly-diagnosed OSA patients, describe their main characteristics and assess continuous positive airway pressure (CPAP) effects on ED. METHODS: Cross-sectional study assessing ED prevalence in OSA patients and open-label, parallel, prospective randomized controlled trial evaluating 3-month CPAP treatment effects on sexual function, satisfaction, and psychological, hormonal and biochemical profiles. Male patients newly diagnosed with moderate/severe OSA (apnea-hypopnea index >20 events·h-1), aged 18-70 years, attending the sleep unit of a Spanish hospital during 2013-2016 were considered. A total of 150 patients were recruited (75 randomized ED patients). ED was defined as scores <25 on International Index Erectile Function 15 test. Wilcoxon's matched-pairs signed-ranks and rank-sum tests were used. RESULTS: ED prevalence was 51%. Patients with ED were older (p<0.001), had greater waist-to-hip ratios (p<0.001), were more frequently undergoing pharmacological treatment (p<0.001) and had higher glucose levels (p = 0.024) than non-ED patients. Although significant increases in erectile function (mean(SD) change: +4.6(7.9); p = 0.002), overall satisfaction (+1(2.2); p = 0.035), and sexual satisfaction (+2.1(4.3); p = 0.003) were found after CPAP treatment, only differences in sexual satisfaction (p = 0.027) and erectile function (p = 0.060) were found between study arms. CPAP treatment did not impact psychological, hormonal or biochemical profiles. CONCLUSIONS: This study confirmed the relationship between OSA and ED, suggesting the potential usefulness of ED screening in OSA patients, but could not determine conclusively whether CPAP is an effective stand-alone ED treatment, regardless of positive results on sexual satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov NCT03086122.

19 Article Management of obstructive sleep apnoea in a primary care vs sleep unit setting: a randomised controlled trial. 2018

Tarraubella, Nuria / Sánchez-de-la-Torre, Manuel / Nadal, Nuria / De Batlle, Jordi / Benítez, Iván / Cortijo, Anunciación / Urgelés, Maria Cruz / Sanchez, Virginia / Lorente, Iñigo / Lavega, M Mercé / Fuentes, Araceli / Clotet, Joan / Llort, Laia / Vilo, Lidia / Juni, M Carmen / Juarez, Aurelia / Gracia, Maribel / Castro-Grattoni, Anabel L / Pascual, Lydia / Minguez, Olga / Masa, Juan F / Barbé, Ferran. ·Atenció Primària Àmbit Lleida, Lleida, Spain. · Translation Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRB Lleida, Lleida, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · Respiratory Unit, Hospital San Pedro de Alcántara, Cáceres, Spain. ·Thorax · Pubmed #30064993.

ABSTRACT: OBJECTIVE: To assess the effectiveness and cost-effectiveness of primary care (PC) and sleep unit (SU) models for the management of subjects with suspected obstructive sleep apnoea (OSA). METHODS: Multicentre, open-label, two-arm, parallel-group, non-inferiority randomised controlled trial. A total of 302 subjects with suspected OSA and/or resistant hypertension were consecutively enrolled, 149 were treated at 11 PC units and 153 patients at a SU. The primary outcomes were a 6-month change in the Epworth Sleepiness Scale (ESS) score and Health Utilities Index (HUI). The non-inferiority margin for the ESS score was -2.0. RESULTS: A total of 80.2% and 70.6% of the PC and SU patients were diagnosed with OSA, respectively, and 59.3% and 60.4% of those were treated with CPAP in PC and SU units, respectively. The Apnoea-Hypopnoea Index was similar between the groups (PC vs SU (median (IQR); 23.1 (26.8) events/h vs 21.8 (35.2) events/h), and the baseline ESS score was higher in the PC than in the SU group (10.3 (6.6) vs 9 (7.2)). After 6 months, the ESS score of the PC group decreased from a mean of 10.1 to 7.6 (-2.49; 95% CI -3.3 to -1.69), and that of the SU group decreased from 8.85 to 5.73 (-3.11; 95% CI -3.94 to 2.28). The adjusted difference between groups for the mean change in the ESS score was -1.25 (one-sided 95% CI -1.88; p=0.025), supporting the non-inferiority of PC management. We did not observe differences in the HUI between groups. The cost analysis showed a median savings of €558.14/patient for the PC setting compared with the SU setting. CONCLUSIONS: Among patients with suspected OSA, the PC model did not result in a worse ESS score or HUI than the specialist model and generated savings in terms of management cost. Therefore, the PC model was more cost-efficient than the SU model. TRIAL REGISTRATION: Results; >>NCT02234765, Clinical Trials.gov.

20 Article Predictors of CPAP compliance in different clinical settings: primary care versus sleep unit. 2018

Nadal, Núria / de Batlle, Jordi / Barbé, Ferran / Marsal, Josep Ramon / Sánchez-de-la-Torre, Alicia / Tarraubella, Nuria / Lavega, Merce / Sánchez-de-la-Torre, Manuel. ·Hospital Universitari Arnau de Vilanova and Santa Maria. IRBLleida, Lleida, Spain. · Primary Care Unit of Lleida, Catalonia, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · Lleida Research Support Unit, Primary Care Research Institute (IDIAP) Jordi Gol, Catalonia, Spain. · Hospital Universitari Arnau de Vilanova and Santa Maria. IRBLleida, Lleida, Spain. sanchezdelatorre@gmail.com. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. sanchezdelatorre@gmail.com. · Hospital Arnau de Vilanova-Santa María, CIBERES, IRBLleida, Avda. Rovira Roure 80, 25198, Lleida, Spain. sanchezdelatorre@gmail.com. ·Sleep Breath · Pubmed #28865067.

ABSTRACT: BACKGROUND: Good adherence to continuous positive airway pressure (CPAP) treatment improves the patient's quality of life and decreases the risk of cardiovascular disease. Previous studies that have analyzed the adherence to CPAP were performed in a sleep unit (SU) setting. The involvement of primary care (PC) in the management of obstructive sleep apnea (OSA) patients receiving CPAP treatment could introduce factors related to the adherence to treatment. OBJECTIVES: The objective was to compare the baseline predictors of CPAP compliance in SU and PC settings. METHODS: OSA patients treated with CPAP were followed for 6 months in SU or PC setting. We included baseline clinical and anthropometrical variables, the Epworth Sleep Scale (ESS) score, the quality of life index, and the Charlson index. A logistic regression was performed for each group to determine the CPAP compliance predictors. Discrimination and calibration were performed using the area under the curve and Hosmer-Lemeshow tests. RESULTS: We included 191 patients: 91 in the PC group and 100 in the SU group. In 74.9% of the patients, the compliance was ≥ 4 h per day, with 80% compliance in the SU setting and 69.2% compliance in the PC setting (p = 0.087). The predictors of CPAP compliance were different between SU and PC settings. Body mass index, ESS, and CPAP pressure were predictors in the SU setting, and ESS, gender, and waist circumference were predictors in the PC setting. CONCLUSIONS: The predictors of adequate CPAP compliance vary between SU and PC settings. Detecting compliance predictors could help in the planning of early interventions to improve CPAP adherence.

21 Article Blood pressure response to CPAP treatment in subjects with obstructive sleep apnoea: the predictive value of 24-h ambulatory blood pressure monitoring. 2017

Castro-Grattoni, Anabel L / Torres, Gerard / Martínez-Alonso, Montserrat / Barbé, Ferran / Turino, Cecilia / Sánchez-de-la-Torre, Alicia / Cortijo, Anunciacion / Duran-Cantolla, Joaquin / Egea, Carlos / Cao, Gonzalo / Sánchez-de-la-Torre, Manuel. ·Respiratory Dept, Hospital University Arnau de Vilanova and Santa Maria; IRB Lleida, University of Lleida, Lleida, Spain. · Both authors contributed equally. · Unit of Biostatistics and Methodological Support, IRB Lleida, Lleida, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · Araba University Hospital, UPV, BioAraba Institute, Vitoria, Spain. · Dept of Laboratory Medicine, University Hospital Arnau de Vilanova, Lleida, Spain. · Respiratory Dept, Hospital University Arnau de Vilanova and Santa Maria; IRB Lleida, University of Lleida, Lleida, Spain sanchezdelatorre@gmail.com. ·Eur Respir J · Pubmed #28982776.

ABSTRACT: The reduction in blood pressure (BP) with continuous positive airway pressure (CPAP) is modest and highly variable. In this study, we identified the variables that predict BP response to CPAP.24-h ambulatory BP monitoring (ABPM), C-reactive protein (CRP), leptin, adiponectin and 24-h urinary catecholamine were measured before and after 6 months of CPAP in obstructive sleep apnoea (OSA) patients.Overall, 88 middle-aged, obese male patients with severe OSA (median apnoea-hypopnoea index 42 events·h

22 Article Characterization of the CPAP-treated patient population in Catalonia. 2017

Turino, Cecilia / Bertran, Sandra / Gavaldá, Ricard / Teixidó, Ivan / Woehrle, Holger / Rué, Montserrat / Solsona, Francesc / Escarrabill, Joan / Colls, Cristina / García-Altés, Anna / de Batlle, Jordi / Sánchez de-la-Torre, Manuel / Barbé, Ferran. ·Group of Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · Department of Computer Science, UPC-BarcelonaTech, Barcelona, Spain. · Department of Computer Science & INSPIRES, University of Lleida, Lleida, Spain. · Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Ulm, Germany. · Unit of Bioestatistics and Epidemiology, IRBLleida, Lleida, Spain. · Chronic Care Program (Hospital Clínic) & Master Plan for Respiratory Diseases (Ministry of Health, Catalonia) & REDISSEC, Barcelona, Spain. · Public Health Department, Government of Catalonia, Barcelona, Spain. ·PLoS One · Pubmed #28934303.

ABSTRACT: There are different phenotypes of obstructive sleep apnoea (OSA), many of which have not been characterised. Identification of these different phenotypes is important in defining prognosis and guiding the therapeutic strategy. The aim of this study was to characterise the entire population of continuous positive airway pressure (CPAP)-treated patients in Catalonia and identify specific patient profiles using cluster analysis. A total of 72,217 CPAP-treated patients who contacted the Catalan Health System (CatSalut) during the years 2012 and 2013 were included. Six clusters were identified, classified as "Neoplastic patients" (Cluster 1, 10.4%), "Metabolic syndrome patients" (Cluster 2, 27.7%), "Asthmatic patients" (Cluster 3, 5.8%), "Musculoskeletal and joint disorder patients" (Cluster 4, 10.3%), "Patients with few comorbidities" (Cluster 5, 35.6%) and "Oldest and cardiac disease patients" (Cluster 6, 10.2%). Healthcare facility use and mortality were highest in patients from Cluster 1 and 6. Conversely, patients in Clusters 2 and 4 had low morbidity, mortality and healthcare resource use. Our findings highlight the heterogeneity of CPAP-treated patients, and suggest that OSA is associated with a different prognosis in the clusters identified. These results suggest the need for a comprehensive and individualised approach to CPAP treatment of OSA.

23 Article Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea. Noninferiority, Randomized Controlled Trial. 2017

Corral, Jaime / Sánchez-Quiroga, Maria-Ángeles / Carmona-Bernal, Carmen / Sánchez-Armengol, Ángeles / de la Torre, Alicia Sánchez / Durán-Cantolla, Joaquín / Egea, Carlos J / Salord, Neus / Monasterio, Carmen / Terán, Joaquín / Alonso-Alvarez, M Luz / Muñoz-Méndez, Jesús / Arias, Eva M / Cabello, Marta / Montserrat, Josep M / De la Peña, Mónica / Serrano, José C / Barbe, Ferran / Masa, Juan F / Anonymous4360987. ·1 San Pedro de Alcántara Hospital, Cáceres, Spain. · 2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. · 3 Virgen del Puerto Hospital, Plasencia, Cáceres, Spain. · 4 Virgen del Rocío Hospital, Sevilla, Spain. · 5 Arnau de Vilanova y Santa María Hospital, Lleida, Spain. · 6 Organización Sanitaria Integrada Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain. · 7 Bellvitge Hospital, Hospitalet de Llobregat, Barcelona, Spain. · 8 Burgos University Hospital, Burgos, Spain. · 9 12 de Octubre Hospital, Madrid, Spain. · 10 Marqués de Valdecilla Hospital, Santander, Spain. · 11 Clinic Hospital, Barcelona, Spain. · 12 Son Espases Hospital, Mallorca, Spain; and. · 13 Llerena-Zafra Hospital, Zafra, Badajoz, Spain. ·Am J Respir Crit Care Med · Pubmed #28636405.

ABSTRACT: RATIONALE: Home respiratory polygraphy may be a simpler alternative to in-laboratory polysomnography for the management of more symptomatic patients with obstructive sleep apnea, but its effectiveness has not been evaluated across a broad clinical spectrum. OBJECTIVES: To compare the long-term effectiveness (6 mo) of home respiratory polygraphy and polysomnography management protocols in patients with intermediate-to-high sleep apnea suspicion (most patients requiring a sleep study). METHODS: A multicentric, noninferiority, randomized controlled trial with two open parallel arms and a cost-effectiveness analysis was performed in 12 tertiary hospitals in Spain. Sequentially screened patients with sleep apnea suspicion were randomized to respiratory polygraphy or polysomnography protocols. Moreover, both arms received standardized therapeutic decision-making, continuous positive airway pressure (CPAP) treatment or a healthy habit assessment, auto-CPAP titration (for CPAP indication), health-related quality-of-life questionnaires, 24-hour blood pressure monitoring, and polysomnography at the end of follow-up. The main outcome was the Epworth Sleepiness Scale measurement. The noninferiority criterion was -2 points on the Epworth scale. MEASUREMENTS AND MAIN RESULTS: In total, 430 patients were randomized. The respiratory polygraphy protocol was noninferior to the polysomnography protocol based on the Epworth scale. Quality of life, blood pressure, and polysomnography were similar between protocols. Respiratory polygraphy was the most cost-effective protocol, with a lower per-patient cost of 416.7€. CONCLUSIONS: Home respiratory polygraphy management is similarly effective to polysomnography, with a substantially lower cost. Therefore, polysomnography is not necessary for most patients with suspected sleep apnea. This finding could change established clinical practice, with a clear economic benefit. Clinical trial registered with www.clinicaltrials.gov (NCT 01752556).

24 Article Cell Death Biomarkers and Obstructive Sleep Apnea: Implications in the Acute Coronary Syndrome. 2017

Bauça, Josep Miquel / Yañez, Aina / Fueyo, Laura / de la Peña, Mónica / Pierola, Javier / Sánchez-de-la-Torre, Alicia / Mediano, Olga / Cabriada-Nuño, Valentín / Masdeu, María José / Teran-Santos, Joaquin / Duran-Cantolla, Joaquin / Masa, Juan Fernando / Abad, Jorge / Sanchez-de-la-Torre, Manuel / Barbé, Ferran / Barceló, Antònia / Anonymous6200903. ·Department of Laboratory Medicine, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain. · Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Palma, Balearic Islands, Spain. · Research Group on Evidence, Lifestyles and Health, Universitat Illes Balears, Palma, Spain. · Respiratory Department, Hospital Universitari Son Espases, Palma, Balearic Islands, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain. · Respiratory Department, Institut de Recerca Biomèdica, Lleida, Catalonia, Spain. · Respiratory Department, Hospital Universitario de Guadalajara, Guadalajara, Castilla-La Mancha, Spain. · Respiratory Department, Hospital Universitario Cruces, Bilbao, Basque Country, Spain. · Respiratory Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de Barcelona. Sabadell, Catalonia, Spain. · Respiratory Department, Hospital Universitario Burgos, Burgos, Castilla-León, Spain. · Research Department, OSI Araba University Hospital, UPV/EHU, Vitoria, Basque Country, Spain. · Respiratory Department, Hospital San Pedro de Alcántara, Cáceres, Extremadura, Spain. · Respiratory Department, Hospital Germans Trias i Pujol, Barcelona, Catalonia, Spain. ·Sleep · Pubmed #28419383.

ABSTRACT: Study Objectives: Nucleosomes and cell-free double-stranded DNA (dsDNA) have been suggested as promising biomarkers in cell death-related diseases, such as acute coronary syndrome (ACS). Currently, the impact of obstructive sleep apnea (OSA) in patients with ACS is unclear. Our aim was to evaluate the relationship between OSA, dsDNA, and nucleosomes and to assess their potential implication in the development of ACS. Methods: Up to 549 patients were included in the study and divided into four groups (145 ACS; 290 ACS + OSA; 62 OSA; 52 controls). All patients underwent a sleep study, and serum concentrations of dsDNA and nucleosomes were measured. Results: Nucleosome and dsDNA levels were higher in patients with OSA than in controls (nucleosomes: 1.47 ± 0.88 arbitary units [AU] vs. 1.00 ± 0.33 AU; p < .001, dsDNA: 315.6 ± 78.0 ng/mL vs. 282.6 ± 55.4 ng/mL; p = .007). In addition, both biomarker levels were higher in patients with ACS than in non-ACS, independently of the presence of OSA. Conclusions: Both nucleosomes and dsDNA are increased in patients with OSA and might be related with the high cardiovascular risk seen in these patients. The extensive cell lysis during a myocardial infarction seems to be the major contributor to the high biomarker levels, and OSA does not seem to be implicated in such elevation when this acute event occurs. Clinical trial registration: NCT01335087 (clinicaltrials.gov).

25 Article Sleep Apnea and Hypertension: Are There Sex Differences? The Vitoria Sleep Cohort. 2017

Cano-Pumarega, Irene / Barbé, Ferrán / Esteban, Andrés / Martínez-Alonso, Montserrat / Egea, Carlos / Durán-Cantolla, Joaquín / Anonymous7200899. ·Respiratory Department, University Hospital of Getafe, Madrid, Spain; Universidad Europea de Madrid, Madrid, Spain. Electronic address: irene.cano@yahoo.com. · Respiratory Department, IRBLleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; University Hospital of Getafe, Madrid, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; Biostatistics Unit, Group of Translational Research in Respiratory Medicine, IRBLleida, Lleida, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; Sleep Unit, OSI Araba University Hospital, Vitoria, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; Research Department, OSI Araba University Hospital, Vitoria, Spain; Bioaraba Research Institute, Vitoria, Spain; Universidad del País Vasco, Vitoria, Spain. ·Chest · Pubmed #28300571.

ABSTRACT: BACKGROUND: Evidence from longitudinal studies has reported contradictory results regarding the association between OSA and hypertension. In a previous analysis of the Vitoria Sleep Cohort, the relationship between OSA and the risk of developing hypertension was evaluated and no independent association after adjustment for confounding factors was found. In the present study, a post hoc analysis to assess the association between OSA and incident stage 2 hypertension (systolic BP ≥ 160 mm Hg and/or diastolic BP ≥ 100 mm Hg) was made on the basis of sex differences. METHODS: A prospective study was performed over 7.5 ± 0.8 years on a middle-aged general population, which included 1,155 normotensive subjects (43.7% men) who completed the follow-up. BP measurements (at baseline and follow-up) and polygraphy at baseline were performed. Logistic regression models were used to determine the association between the respiratory disturbance index (RDI) and stage 2 hypertension and a recursive partitioning method was used to determine the variables related to the incidence of stage 2 hypertension. The RDI was divided into subgroups (0-2.9, 3-6.9, 7-13.9, and ≥ 14), using the first subgroup as reference. RESULTS: For men, an RDI ≥ 14 was associated with a significantly increased OR for stage 2 hypertension (OR, 2.54 [95% CI, 1.09-5.95], P = .032). This association was not statistically significant among women (P = .371). CONCLUSIONS: The results suggest an association between moderate and severe OSA, and the incidence of more severe forms of hypertension occurring in men but not in women. However, because this is a community-based study, the women's population characteristics may differ from women usually seen in sleep-disorders clinics.

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