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Sleep Apnea Syndromes: HELP
Articles by Venerino Poletti
Based on 9 articles published since 2008
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Between 2008 and 2019, Venerino Poletti wrote the following 9 articles about Sleep Apnea Syndromes.
 
+ Citations + Abstracts
1 Review Phenotyping the pathophysiology of obstructive sleep apnea using polygraphy/polysomnography: a review of the literature. 2018

Bosi, Marcello / De Vito, Andrea / Kotecha, Bhik / Viglietta, Luca / Braghiroli, Alberto / Steier, Joerg / Pengo, Martino / Sorrenti, Giovanni / Gobbi, Riccardo / Vicini, Claudio / Poletti, Venerino. ·AUSL of Romagna, Department Thoracic Diseases, Pulmonary Operative Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. · AUSL of Romagna, Head and Neck Department, ENT Unit, Morgagni-Pierantoni Hospital, Via Dei Gerolimini 12, 47121, Forlì, Italy. dr.andrea.devito@gmail.com. · Department of Otolaryngology-Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK. · AUSL of Romagna, Department of Thoracic Diseases, Pulmonary Operative Unit, Umberto I Hospital, Lugo, Italy. · Department of Pulmonary Rehabilitation, Sleep Laboratory, Istituti Clinici Scientifici Maugeri, SPA SB, IRCCS, Veruno, Italy. · Faculty of Life Sciences and Medicine, King's College London, London, UK. · Lane Fox Respiratory Unit/Sleep Disorders Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK. · AOU of Bologna, ENT Clinic, Faculty of Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy. · AUSL of Romagna, Head and Neck Department, ENT Unit, Morgagni-Pierantoni Hospital, Via Dei Gerolimini 12, 47121, Forlì, Italy. · University of Ferrara, Ferrara, Italy. · Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark. ·Sleep Breath · Pubmed #29318567.

ABSTRACT: Continuous positive airway pressure (CPAP) is the first-line treatment for the majority of patients affected by obstructive sleep apnea syndrome (OSA). However, long-term compliance with CPAP therapy may result limited and alternatives to CPAP therapy are required to address the increasing need to provide tailored therapeutic options. Understanding the pathophysiological traits (PTs) of OSA patients [upper airway (UA) anatomical collapsibility, loop gain (LG), arousal threshold (AT), and UA gain (UAG)] lies at the heart of the customized OSA treatment. However, sleep research laboratories capable to phenotype OSA patients are sparse and the diagnostic procedures time-consuming, costly, and requiring significant expertise. The question arises whether the use of routine clinical polysomnography or nocturnal portable multi-channel monitoring (PSG/PM) can provide sufficient information to characterize the above traits. The aim of the present review is to deduce if the information obtainable from the clinical PSG/PM analysis, independently of the scope and context of the original studies, is clinically useful to define qualitatively the PTs of individual OSA patients. In summary, it is possible to identify four patterns using PSG/PM that are consistent with an altered UA collapsibility, three that are consistent with altered LG, two with altered AT, and three consistent with flow limitation/UA muscle response. Furthermore, some PSG/PM indexes and patterns, useful for the suitable management of OSA patient, have been discussed. The delivery of this clinical approach to phenotype pathophysiological traits will allow patients to benefit in a wider range of sleep services by facilitating tailored therapeutic options.

2 Review The importance of obstructive sleep apnoea and hypopnea pathophysiology for customized therapy. 2017

Bosi, Marcello / De Vito, Andrea / Gobbi, Riccardo / Poletti, Venerino / Vicini, Claudio. ·Pneumology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. · Head & Neck Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, 47121, Forlì, Italy. dr.andrea.devito@gmail.com. · Head and Neck Department, ENT Unit, Sant'Orsola University Hospital, Bologna, Italy. · Head & Neck Department, Ear-Nose-Throat Unit, Morgagni-Pierantoni Hospital, 47121, Forlì, Italy. ·Eur Arch Otorhinolaryngol · Pubmed #27470114.

ABSTRACT: The objective of this study is to highlight the importance of anatomical and not-anatomical factors' identification for customized therapy in OSAHS patients. The data sources are: MEDLINE, The Cochrane Library and EMBASE. A systematic review was performed to identify studies that analyze the role of multiple interacting factors involved in the OSAHS pathophysiology. 85 out of 1242 abstracts were selected for full-text review. A variable combinations pathophysiological factors contribute to realize differentiated OSAHS phenotypes: a small pharyngeal airway with a low resistance to collapse (increased critical closing pressure), an inadequate responses of pharyngeal dilator muscles (wakefulness drive to breathe), an unstable ventilator responsiveness to hypercapnia (high loop gain), and an increased propensity to wake related to upper airway obstruction (low arousal threshold). Identifying if the anatomical or not-anatomical factors are predominant in each OSAHS patient represents the current challenge in clinical practice, moreover for the treatment decision-making. In the future, if a reliable and accurate pathophysiological pattern for each OSAHS patient can be identified, a customized therapy will be feasible, with a significant improvement of surgical success in sleep surgery and a better understanding of surgical failure.

3 Review Sleep and respiratory sleep disorders in idiopathic pulmonary fibrosis. 2016

Milioli, Giulia / Bosi, Marcello / Poletti, Venerino / Tomassetti, Sara / Grassi, Andrea / Riccardi, Silvia / Terzano, Mario Giovanni / Parrino, Liborio. ·Sleep Disorders Center, Dept of Neurosciences, University of Parma, Italy. Electronic address: giulia.milioli@gmail.com. · Pulmonary Operative Unit, Dept of Thoracic Diseases, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy. · Sleep Disorders Center, Dept of Neurosciences, University of Parma, Italy. ·Sleep Med Rev · Pubmed #26168886.

ABSTRACT: Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease (ILD) characterized by inflammation and progressive scarring of the lung parenchyma. IPF profoundly affects the quality of life (QoL) and fatigue is a frequently disabling symptom. The cause of fatigue is not well understood but patients with IPF often report extremely poor sleep quality and sleep-related breathing disorders (SRBD) that correlate with QoL. IPF patients present alterations in sleep architecture, including decreased sleep efficiency, slow wave sleep and rapid eye movement (REM) sleep, and increased sleep fragmentation. Moreover, sleep related hypoventilation during the vulnerable REM sleep period and obstructive sleep apnea-hypopnea syndrome (OSAHS) are frequent, but remain usually underdiagnosed. These SRBD in IPF are associated with alterations of the sleep structure, reduction of QoL and increased risk of mortality. In the absence of an effective therapy for IPF, optimizing the QoL could become the primary therapeutic goal. In this perspective the diagnosis and treatment of SRBD could significantly improve the QoL of IPF patients.

4 Review Idiopathic pulmonary fibrosis and sleep disorders: no longer strangers in the night. 2015

Schiza, Sophia / Mermigkis, Charalampos / Margaritopoulos, George A / Daniil, Zoi / Harari, Sergio / Poletti, Venerino / Renzoni, Elizabetta A / Torre, Olga / Visca, Dina / Bouloukaki, Isolde / Sourvinos, George / Antoniou, Katerina M. ·Dept of Thoracic Medicine, Sleep Disorders Center, Medical School, University of Crete, Heraklion, Greece Both authors contributed equally. · Dept of Thoracic Medicine, Interstitial Lung Disease Unit & Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Greece Dept of Respiratory Medicine, General Hospital of Kavala, Kavala, Greece. · Respiratory Medicine Dept, University Hospital of Larissa, Larissa, Greece. · U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe - MultiMedica, Milan, Italy. · Dept of Diseases of the Thorax/Pulmonology Unit, Ospedale GB Morgagni, Forlì, Italy. · Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK. · Dept of Thoracic Medicine, Sleep Disorders Center, Medical School, University of Crete, Heraklion, Greece. · Laboratory of Virology, Medical School, University of Crete, Heraklion, Greece. · Dept of Thoracic Medicine, Interstitial Lung Disease Unit & Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Greece kantoniou@med.uoc.gr. ·Eur Respir Rev · Pubmed #26028644.

ABSTRACT: The prevalence of obstructive sleep apnoea (OSA) is continuously increasing in patients with idiopathic pulmonary fibrosis (IPF) and, for the first time, the recent IPF guidelines recognise OSA as an important associated comorbidity that can affect patient's survival. Thus, it becomes conceivable that clinicians should refer patients with newly diagnosed IPF to sleep centres for the diagnosis and treatment of OSA as well as for addressing issues regarding the reduced compliance of patients with continuous positive airway pressure therapy. The discovery of biomarkers common to both disorders may help early diagnosis, institution of the most appropriate treatment and follow-up of patients. Better understanding of epigenetic changes may provide useful information about pathogenesis and, possibly, development of new drugs for a dismal disease like IPF.

5 Article OSA and Prolonged Oxygen Desaturation During Sleep are Strong Predictors of Poor Outcome in IPF. 2017

Bosi, Marcello / Milioli, Giulia / Fanfulla, Francesco / Tomassetti, Sara / Ryu, Jay H / Parrino, Liborio / Riccardi, Silvia / Melpignano, Andrea / Vaudano, Anna Elisabetta / Ravaglia, Claudia / Tantalocco, Paola / Rossi, Andrea / Poletti, Venerino. ·Department of Diseases of the Thorax, GB Morgagni Hospital, Asl Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy. marcello.bosi@libero.it. · Sleep Disorders Center, Dept of Neurosciences, University of Parma, Parma, Italy. · Sleep Medicine Unit and Sleep Research Laboratory S. Maugeri Foundation IRCCS - Scientific Insitute of Pavia, Pavia, Italy. · Department of Diseases of the Thorax, GB Morgagni Hospital, Asl Romagna, Via Carlo Forlanini, 34, 47121, Forlì, Italy. · Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA. · Pulmonology Operative Unit, Verona University, Verona, Italy. · Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark. ·Lung · Pubmed #28674777.

ABSTRACT: PURPOSE: Sleep Breathing Disorders (SBD) are frequently found in idiopathic pulmonary fibrosis (IPF) and they are associated with worse quality of sleep and life and with higher mortality. The study aimed at evaluating the impact of SBD on prognosis (mortality or disease progression) in 35 patients with mild to moderate IPF. METHODS AND RESULTS: Obstructive sleep apnea (OSA) was diagnosed in 25/35 patients with IPF: 14/35 mild, 7/35 moderate, and 4/35 severe. According to the American Academy of Sleep Medicine (AASM) definition, sleep-related hypoxemia was found in 9/35 patients with IPF. According to the presence/absence of SBD, IPF patients were divided into 4 groups: NO-SBD group (Group A, 25.7%), OSA without sleep-related hypoxemia (Group B, 48.5%), OSA with sleep-related hypoxemia group (Group C, 22.8%), and only 1/35 had sleep-related hypoxemia without OSA(Group D, 2.8%). Statistical analysis was focused only on group A, B, and C. Patients with OSAS and sleep-related hypoxemia (Group C) had the worse prognosis, both in terms of mortality or clinical deterioration. SBD were the only independent risk factor (Cox Proportional Hazards Multiple Regression Analysis) for mortality (HR 7.6% IC 1.2-36.3; p = 0.029) and disease progression (HR 9.95% IC 1.8-644.9; p = 0.007). CONCLUSIONS: SBD are associated with a worse prognosis, both in terms of mortality or clinical progression. The presence of SBD should be explored in all IPF patients.

6 Article The interpretation of compact polysomnography/polygraphy in sleep breathing disorders patients: a validation's study. 2017

Bosi, Marcello / De Vito, Andrea / Bellini, Chiara / D'Agostino, Giovanni / Firinu, Elisabetta / Gobbi, Riccardo / Pacella, Alessandro / Filograna Pignatelli, Giulio / Zeccardo, Ermelinda / Poletti, Venerino / Vicini, Claudio. ·Department of Diseases of the Thorax, GB Morgagni-Pierantoni Hospital, AUSL of Romagna, Forlì, Italy. · Ear-Nose-Throat Unit, Head and Neck Department, Morgagni-Pierantoni Hospital, AUSL of Romagna, 47121, Forlì, Italy. dr.andrea.devito@gmail.com. · Ear-Nose-Throat Unit, Head and Neck Department, Morgagni-Pierantoni Hospital, AUSL of Romagna, 47121, Forlì, Italy. · Oral Medical and Biotechnological Science Department, Obstructive Sleep Breathing Disorders Screening University Center, G. D'Annunzio University, Chieti, Italy. · Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark. · ENT Clinic, University of Ferrara, Ferrara, Italy. ·Eur Arch Otorhinolaryngol · Pubmed #28451755.

ABSTRACT: The Otorhinolaryngologist (ENT) frequently has to deal with OSA or suspicious OSA patients and undergone polysomnography (PSG) or portable monitoring (PM) and should be confident about the quality and consistency of the polysomnographic diagnosis. The main polysomnographic traces compressed in a unique epoch, defined as compact PSG/PM (CP), could represent an efficient tool to confirm the quality of PSG/PM Sleep Breathing Disorders diagnosis. This is a validation's study of a CP interpretation's method, analyzing the learning curve, the level of diagnostic accuracy, and the inter-operator agreement in interpreting the CP pattern between a group of ENT specialists not skilled in PSG/PM scoring, but managing SBD patients during daily practice. Seven ENT specialists have been enrolled in the study. 50 CP traces (ranging from normal to all main SBD patterns) have been showed to each participant for the interpretation and scoring process, before and after a 2-h theoretical-practical interactive lesson, focusing on the recognition of the four main oximetric patterns on CP traces (normal, phasic, prolonged, and overlap patterns). RESULTS: before and after the theoretical-practical interactive lesson, the whole diagnostic accuracy in interpreting the 50 CP has been reported improved from 0.12 to 0.80 (median 0.52) to 0.82-0.96 (median 0.92) (p = 0.006) and the inter-scorers' agreement showed a kappa value increased from of 0.18 to 0.75 (p < 0.0001). A complete clinical diagnostic evaluation is essential in OSA patients and the ENT specialist should be concerned to verify if the patient, suitable for surgical therapy, is affected really by an isolated form of OSA. The CP interpretation allows a checking of the proper nosographic SBD framework and could be significantly important for all ENT specialists not skilled in PSG/PM scoring, but managing SBD patients during daily practice. The data reported in our validation's study showed that the CP interpretation's method is easy to apply, with a rapid learning curve. The level of diagnostic accuracy is high with a high inter-scorer agreement in interpreting the CP patterns.

7 Article The role of compact polysomnography/polygraphy in sleep breathing disorder patients' management. 2017

Bosi, Marcello / De Vito, Andrea / Vicini, Claudio / Poletti, Venerino. ·Pneumology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy. · Ear-Nose-Throat Unit, Head and Neck Department, Morgagni-Pierantoni Hospital, 47121, Forlì, Italy. dr.andrea.devito@gmail.com. · Ear-Nose-Throat Unit, Head and Neck Department, Morgagni-Pierantoni Hospital, 47121, Forlì, Italy. ·Eur Arch Otorhinolaryngol · Pubmed #27844222.

ABSTRACT: While managing obstructive sleep apnea (OSA) or suspicious OSA patients, the otorhinolaryngologist frequently has to deal with patients undergoing repeated polysomnography (PSG) or portable monitoring (PM) and, on the other hand, should be confident about the quality and consistency of the polysomnographic diagnosis. The main polysomnographic traces compressed in a unique epoch, defined as compact PSG/PM (CP), which should be reported in all PSG/PM report, could represent an efficient tool to confirm the quality of PSG/PM diagnosis and to recognize the sleep breathing disorders (SBD): OSA, no-OSA SBD and overlap of OSA with no-OSA SBD. In this study, a synthetic and clear guided iconography and an easy decision-making algorithm based on desaturation patterns (phasic, prolonged and overlap desaturation patterns) identifiable on the CP are suggested for a quick check of the quality of PSG/PM diagnosis and to achieve an improvement in the patient's clinical management.

8 Article Can sleep microstructure improve diagnosis of OSAS? Integrative information from CAP parameters. 2015

Milioli, Giulia / Bosi, Marcello / Grassi, Andrea / Riccardi, Silvia / Terzano, Mario Giovanni / Cortelli, Pietro / Poletti, Venerino / Parrino, Liborio. ·Sleep Disorders Center, Dept of Neurosciences, University of Parma, Italy. Email: giulia.milioli@gmail.com. ·Arch Ital Biol · Pubmed #26742673.

ABSTRACT: PURPOSE: The scoring of American Academy of Sleep Medicine (AASM) arousal is mandatory for the definition of respiratory event-related arousal (RERA). However there are other EEG activation phenomena, such as A phases of cyclic alternating pattern (CAP) which are associated with respiratory events in non rapid eye movements (NREM) sleep. This study aims at quantifying the additional value of CAP for the definition of respiratory events and sleep alterations in OSAS. METHODS: Analysis of polysomnographic recordings from nineteen OSAS patients was carried out. Scoring was focused on investigation of the cerebral response to flow limitation (FL) events. For this purpose we used both CAP rules and AASM arousal criteria. MAIN RESULTS: While no difference was demonstrated in the arousal index between mild and moderate-severe OSAS patients, CAP time showed a progressive enhancement from normal subjects (152.5±20.76) to mild (180.64±34.76) and moderate-severe (282.27±58.02) OSAS patients. In NREM sleep, only 41.1% of FL events met the criteria for the definition of RERA, while, 75.5% of FL events ended with a CAP A phase and most FL CAP (69.1%) terminated with a CAP phase A3 subtype. CONCLUSIONS: Our data indicate that the RERA scoring has a limited accuracy in the detection of FL events. In NREM sleep, CAP rules provided more information than AASM arousal for the definition of respiratory events and sleep alterations in OSAS.

9 Article The predictive value of Muller's maneuvre for CPAP titration in OSAHS patients. 2013

Bosi, Marcello / De Vito, Andrea / Vicini, Claudio / Poletti, Venerino. ·Thoracic Diseases Department, Morgagni-Pierantoni Hospital, Forli, Italy. ·Eur Arch Otorhinolaryngol · Pubmed #23463348.

ABSTRACT: To investigate the role of awake upper airways (UA) endoscopy assessment as a parameter of prediction for CPAP titration in OSAHS patient therapy. Retrospective analysis of UA endoscopic assessment with Mueller's maneuvre and the application of the nose oropharynx hypopharynx score (NOHs) was conducted to obtain a numeric score representing the grade of severity of UA obstruction. Other commonly used predictive parameters for CPAP titration were also included in the study: anthropometric [BMI, neck circumference (NC)] and polysomnographic parameters (AHI, ODI). 3 groups of patients were identified: (1) 67/90 patients requiring intermediate CPAP values, (2) 13/90 patients requiring high CPAP values, and (3) 10/90 patients requiring low pressure values. BMI (p = 0.0013) was the only monitored parameter to show significant statistical value as a CPAP titration predictor. However, higher values of anthropometric parameters (NOHs ≥9, BMI >35, NC >45) showed a sensitivity of 69.2% as a single parameter and 76.9% as combined parameters, and specificity between 66.2 and 72.7% as a single parameter and 43.4% as combined parameters, unequivocally identifying patients requiring high therapeutic CPAP value. A lower cut-off of anthropometric parameters (NOHs ≤6, BMI ≤29, NC <42) showed sensitivity between 40 and 60% as a single parameter and of 90% as combined parameters, and specificity between 68.7 and 80.2% as a single parameter which increased to 93.7% as combined parameters, identifying patients requiring a low therapeutic CPAP value. The results show that anthropometric and polygraphic parameters have no significant independent predictive value for CPAP titration, with the exception of BMI. However, anthropometric parameters showed good levels of sensitivity and specificity in OSAHS patients requiring high or low levels of CPAP therapy.