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Sleep Apnea Syndromes: HELP
Articles from San Luca Hospital
Based on 22 articles published since 2010
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These are the 22 published articles about Sleep Apnea Syndromes that originated from San Luca Hospital during 2010-2020.
 
+ Citations + Abstracts
1 Guideline Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders. 2019

Silvestri, R / Aricò, I / Bonanni, E / Bonsignore, M / Caretto, M / Caruso, D / Di Perri, M C / Galletta, S / Lecca, R M / Lombardi, C / Maestri, M / Miccoli, M / Palagini, L / Provini, F / Puligheddu, M / Savarese, M / Spaggiari, M C / Simoncini, T. ·Center of Sleep Medicine, UOSD of Neurophysiopathology and Disorders of Movement, AOU G Martino, Department of Clinical and Experimental Medicine, University of Messina, Italy. Electronic address: rsilvestri@unime.it. · Center of Sleep Medicine, UOSD of Neurophysiopathology and Disorders of Movement, AOU G Martino, Department of Clinical and Experimental Medicine, University of Messina, Italy. · Division of Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Italy. · Division of Pneumology, University Hospital AOUP "Paolo Giaccone" PROMISE Department, University of Palermo, Italy. · Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Italy. · Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Italy. · Sleep Disorder Centre, Department of Medical Sciences and Public Health, University of Cagliari, Italy. · Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. · Department of Clinical and Experimental Medicine, University of Pisa, Italy. · IRCCS, Institute of Neurological Sciences, Bologna, Italy; Department of BioMedical and NeuroMotor Sciences, University of Bologna, Italy. · "FM Puca" Neurology Unit, University Hospital Consortium Corporation Polyclinic of Bari, Italy. · Neurological Day Care Unit - Local Health Authority (AUSL 4), Parma, Italy. ·Maturitas · Pubmed #31547910.

ABSTRACT: Insomnia, vasomotor symptoms (VMS) and depression often co-occur after the menopause, with consequent health problems and reductions in quality of life. The aim of this position statement is to provide evidence-based advice on the management of postmenopausal sleep disorders derived from a systematic review of the literature. The latter yielded results on VMS, insomnia, circadian rhythm disorders, obstructive sleep apnea (OSA) and restless leg syndrome (RLS). Overall, the studies show that menopausal hormone therapy (MHT) improves VMS, insomnia, and mood. Several antidepressants can improve insomnia, either on their own or in association with MHT; these include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and mirtazapine. Long-term benefits for postmenopausal insomnia may also be achieved with non-drug strategies such as cognitive behavioral therapy (CBT) and aerobic exercise. Continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) both reduce blood pressure and cortisol levels in postmenopausal women suffering from OSA. However, the data regarding MHT on postmenopausal restless legs syndrome are conflicting.

2 Editorial Is intensified diuretic therapy an effective new treatment strategy in obstructive sleep apnoea patients with uncontrolled hypertension? 2014

Lombardi, Carolina / Mariani, Davide / Parati, Gianfranco. ·aSleep Disorders Center bCardiology Unit, Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano IRCCS cDepartment of Health Science, University of Milano-Bicocca, Milan, Italy. ·J Hypertens · Pubmed #24477095.

ABSTRACT: -- No abstract --

3 Review Comorbidities in chronic heart failure: An update from Italian Society of Cardiology (SIC) Working Group on Heart Failure. 2020

Correale, Michele / Paolillo, Stefania / Mercurio, Valentina / Limongelli, Giuseppe / Barillà, Francesco / Ruocco, Gaetano / Palazzuoli, Alberto / Scrutinio, Domenico / Lagioia, Rocco / Lombardi, Carolina / Lupi, Laura / Magrì, Damiano / Masarone, Daniele / Pacileo, Giuseppe / Scicchitano, Pietro / Matteo Ciccone, Marco / Parati, Gianfranco / Tocchetti, Carlo G / Nodari, Savina. ·Department of Cardiology, University Hospital Foggia, Italy. Electronic address: opsfco@tin.it. · Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. · Department of Translational Medical Sciences, Federico II University, Naples, Italy. · Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy; Department of Translational Medical Sciences, Luigi Vanvitelli University, Naples, Italy; Institute of Cardiovascular Sciences, University College of London, London, United Kingdom. · Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Sapienza" University of Rome, Italy. · Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy. · Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy. · Cardiology Department, IRCCS "S. Maugeri" Cassano (BA), Bari, Italy. · Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences. San Luca Hospital, Milan, Italy. · Section of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy. · Department of Clinical and Molecular Medicine, University "La Sapienza", Rome, Italy. · Heart Failure Unit, AORN dei Colli, Monaldi Hospital, Naples, Italy. · Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari "A. Moro", Bari, Italy. ·Eur J Intern Med · Pubmed #31708358.

ABSTRACT: The increasing number of patients with heart failure HF and comorbidities is due to aging population and increase of life expectancy of patients with cardiovascular disease. Encouraging results derived by recent trials may suggest some comorbidities as new targets for new drugs, highlighting the need for a better understanding of the comorbidities' effects in HF patients and the need of a multidisciplinary approach for the management of chronic HF with comorbidities. We report a brief review about main cardiovascular and non-cardiovascular comorbidities in HF patients in order to update physicians and researchers engaged in the HF research or in "fight against heart failure."

4 Review Menopause and Sleep Apnea. 2019

Perger, Elisa / Mattaliano, Paola / Lombardi, Carolina. ·Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy. · Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. Electronic address: c.lombardi@auxologico.it. ·Maturitas · Pubmed #31097176.

ABSTRACT: Obstructive sleep apnea (OSA) is a chronic and common adult disorder characterized by recurrent episodes of upper-airway obstruction and reopening during sleep. OSA is associated with intermittent hypoxia, sympathetic overactivity, oxidative stress and high cardiovascular mortality and morbidity. It is known to be more common in men than women, partly due to differences in anatomy and functional respiratory components. There are also gender differences in reported symptoms, leading to potential under-diagnosis in females. This gender difference tends to decrease after menopause, demonstrating a role of menopausal status itself in OSA phenotypes. Aging, fat mass distribution, sex hormones and upper-airway collapsibility are postulated to play a major role in these findings. This review focuses on the most recent studies exploring gender differences in the prevalence, pathogenesis and clinical features of OSA. It discusses the role of menopause in this, and explore the underlying pathophysiological mechanisms.

5 Review Hypertension and atrial fibrillation in obstructive sleep apnea: Is it a menopause issue? 2019

Perger, Elisa / Pengo, Martino F / Lombardi, Carolina. ·Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy. · Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. Electronic address: c.lombardi@auxologico.it. ·Maturitas · Pubmed #31097175.

ABSTRACT: Obstructive sleep apnoea (OSA) is a common disorder, in which loss of pharyngeal dilator muscle tone during sleep causes recurrent collapse of the upper airway and temporary cessation of breathing. Repeated apneas and hypopneas lead to cycles of intermittent hypoxia/hypercapnia, increased negative intrathoracic pressure and arousals from sleep. These consequences of OSA are associated with a cascade of cardiovascular and neurohumoral consequences, including sympathetic nervous system hyperactivity, raised heart rate variability, increases in blood pressure, myocardial wall stress, oxidative stress, systemic inflammation, platelet aggregation and impaired vascular endothelial function, which contribute, in turn, to increased cardiovascular risk and, in particular, to the development of chronic systemic arterial hypertension and arrhythmias, especially atrial fibrillation (AF). Given that the prevalence of OSA is modified by age and gender, OSA-related cardiovascular diseases may also be affected by the same factors. This review focuses on the potential role of OSA in systemic arterial hypertension and AF, and discusses the most interesting studies on age and gender as predisposing factors.

6 Review Obstructive Sleep Apnea and Hypertension: Why Treatment Does Not Consistently Improve Blood Pressure. 2019

Parati, Gianfranco / Pengo, Martino Francesco / Lombardi, Carolina. ·Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, Milan, Italy. gianfranco.parati@unimib.it. · Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. gianfranco.parati@unimib.it. · Sleep Disorder Centre, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Via Magnasco, 2, Milan, Italy. · Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ·Curr Hypertens Rep · Pubmed #30949909.

ABSTRACT: PURPOSE OF REVIEW: Obstructive sleep apnea (OSA) and hypertension are two phenomena deeply linked together and, although a causal relationship has been suggested, a recent meta-analysis showed only a very modest effect of OSA treatment on blood pressure (BP). However, a vast number of randomized controlled trials published so far share some limitations, mainly of methodological nature: neither OSA nor BP is always assessed in a standardized way. Moreover, compliance with OSA treatment is often sub-optimal making the results of these trials difficult to interpret. RECENT FINDINGS: Recent studies have shown that antihypertensive drugs can reduce BP more than OSA treatment, showing a better compliance profile and very few side effects. Considering the importance of reducing the overall cardiovascular risk of OSA patients, a more careful management of patient's antihypertensive medication could allow a better BP control also in this condition. In addition, greater efforts should be made to improve patient's acceptance of OSA treatment with the aim of improving their compliance.

7 Review Systemic hypertension in obstructive sleep apnea. 2018

Lombardi, Carolina / Pengo, Martino F / Parati, Gianfranco. ·Istituto Auxologico Italiano, IRCCS, Dipartimento di Scienze Cardiovascolari, Neurologiche e Metaboliche, S.Luca Hospital, Milan, Italy. · Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ·J Thorac Dis · Pubmed #30687539.

ABSTRACT: There is consistent epidemiological evidence that sleep disordered breathing and systemic arterial hypertension are deeply associated, being linked through a bidirectional complex interaction among multiple mechanisms including autonomic nervous system alterations, inflammation, hormonal and hemodynamic components, sleep alterations. However there are several unanswered questions not only from a pathophysiological perspective, but also regarding the effects of obstructive sleep apnea (OSA) treatment on arterial blood pressure values. At present, while many studies have supported the possibility to obtain at least a small blood pressure reduction with OSA treatment, in particular in hypertensive patients, large trials have not clearly confirmed a significant anti-hypertensive effect, nor a beneficial effect of this intervention on cardiovascular endpoints including cardiovascular mortality. Aim of the present review article is to address the relationship between OSA and hypertension in the light of the latest evidence in the field. Moreover we will discuss research topics which need to be investigated in the future, in order to better clarify still pending issues with the aim of obtaining an early diagnosis, a more suitable phenotyping including comorbidities, and better strategies to improve patients' compliance and adherence to treatment.

8 Review Obstructive Ventilatory Disorder in Heart Failure-Caused by the Heart or the Lung? 2016

Caravita, Sergio / Vachiéry, Jean-Luc. ·Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy. · Pulmonary Hypertension and Heart Failure Clinic, Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium. · Pulmonary Hypertension and Heart Failure Clinic, Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Brussels, Belgium. jeanluc.vachiery@erasme.ulb.ac.be. · Department of Cardiology, CUB Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium. jeanluc.vachiery@erasme.ulb.ac.be. ·Curr Heart Fail Rep · Pubmed #27817003.

ABSTRACT: Heart failure (HF) is a clinical syndrome frequently associated with airway obstruction, either as a respiratory comorbidity or as a direct consequence of HF pathophysiology. Recognizing the relative contribution of an underlying airway disease as opposed to airway obstruction due to volume overload and left atrial pressure elevation is of importance for the appropriate management of patients affected by HF. This review focuses on "les liaisons dangereuses" between the heart and the lungs, outlying recent advances linking in a vicious circle of chronic obstructive lung disease (COPD) and obstructive sleep apnea (OSA) on one side and HF on the other side. It also discusses the role of pivotal diagnostic tools such as pulmonary function tests and cardiopulmonary exercise test to determine the contribution of HF and COPD to symptoms and clinical status. Treatment implications are discussed as well.

9 Review Heart failure and sleep disorders. 2016

Parati, Gianfranco / Lombardi, Carolina / Castagna, Francesco / Mattaliano, Paola / Filardi, Pasquale Perrone / Agostoni, Piergiuseppe / Anonymous6760867. ·Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Piazza Brescia 20, 20149 Milan, Italy. · Sleep Medicine Centre, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milan, Italy. · Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, 20126 Milan, Italy. · Department of Medicine, Columbia University, 622 West 168th Street, New York, New York 10032, USA. · Department of Advanced Biomedical Sciences, Federico II University, Corso Umberto I 40, 80138 Naples, Italy. · Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milan, Italy. · Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy. ·Nat Rev Cardiol · Pubmed #27173772.

ABSTRACT: Awareness of the importance of sleep-related disorders in patients with cardiovascular diseases is growing. In particular, sleep-disordered breathing, short sleep time, and low sleep quality are frequently reported by patients with heart failure (HF). Sleep-disordered breathing, which includes obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is common in patients with HF and has been suggested to increase the morbidity and mortality in these patients. Both OSA and CSA are associated with increased sympathetic activation, vagal withdrawal, altered haemodynamic loading conditions, and hypoxaemia. Moreover, OSA is strongly associated with arterial hypertension, the most common risk factor for cardiac hypertrophy and failure. Intrathoracic pressure changes are also associated with OSA, contributing to haemodynamic alterations and potentially affecting overexpression of genes involved in ventricular remodelling. HF treatment can decrease the severity of both OSA and CSA. Indeed, furosemide and spironolactone administration, exercise training, cardiac resynchronization therapy, and eventually heart transplantation have shown a positive effect on OSA and CSA in patients with HF. At present, whether CSA should be treated and, if so, which is the optimal therapy is still debated. By contrast, more evidence is available on the beneficial effects of OSA treatment in patients with HF.

10 Review Obstructive sleep apnea syndrome as a cause of resistant hypertension. 2014

Parati, Gianfranco / Ochoa, Juan Eugenio / Bilo, Grzegorz / Mattaliano, Paola / Salvi, Paolo / Kario, Kazuomi / Lombardi, Carolina. ·1] Division of Cardiovascular Medicine, Department of Health Sciences, University of Milano-Bicocca, Milan, Italy [2] Department of Cardiology, S.Luca Hospital, IRCCS Istituto Auxologico Italiano and University of Milan-Bicocca, Piazza Brescia 20, Milan, Italy. · 1] Department of Cardiology, S.Luca Hospital, IRCCS Istituto Auxologico Italiano and University of Milan-Bicocca, Piazza Brescia 20, Milan, Italy [2] Department of Health Sciences, University of Milano-Bicocca, Milan, Italy. · Department of Cardiology, S.Luca Hospital, IRCCS Istituto Auxologico Italiano and University of Milan-Bicocca, Piazza Brescia 20, Milan, Italy. · Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. ·Hypertens Res · Pubmed #24804613.

ABSTRACT: Evidence has consistently supported the association of obstructive sleep apnea syndrome (OSAS) with an increased prevalence of hypertension. It has also been shown that the severity of OSAS is directly correlated with the degree of blood pressure (BP) elevation and that hypertension occurring in subjects with OSAS is more likely to be severe, resistant to antihypertensive treatment and associated with alterations in day-to-night BP changes. Proposed mechanisms for the pathogenesis of OSAS-related hypertension include the activation of the sympathetic nervous system, alterations in autonomic cardiovascular (CV) modulation, the activation of the renin-angiotensin-aldosterone system, endothelial dysfunction, systemic and vascular inflammation, oxidative stress, metabolic abnormalities, arterial stiffness and alterations in cardiac function and structure. Given the adverse prognostic implications of OSAS-related hypertension for CV morbidity and mortality, the confirmation of resistant hypertension by using ambulatory BP monitoring (ABPM) and the identification of alterations in day-to-night BP changes is of the utmost importance to implement more aggressive strategies for achieving BP control. In turn, the proper identification and implementation of specific treatment strategies for OSAS (that is, continuous positive airway pressure) in subjects with resistant hypertension may promote BP control and optimize CV protection. The present paper will review the evidence supporting the association of OSAS with resistant hypertension and the proposed mechanisms for this association. It will also address the role of ABPM in the confirmation of resistant hypertension in subjects with OSAS and whether the proper identification and management of OSAS in subjects with resistant hypertension will improve BP control.

11 Review The human sympathetic nervous system: its relevance in hypertension and heart failure. 2012

Parati, Gianfranco / Esler, Murray. ·Department of Cardiology, S Luca Hospital, IRCCS Istituto Auxologico Italiano, piazza Brescia 20, 20149 Milan, Italy. gianfranco.parati@unimib.it ·Eur Heart J · Pubmed #22507981.

ABSTRACT: Evidence assembled in this review indicates that sympathetic nervous system dysfunction is crucial in the development of heart failure and essential hypertension. This takes the form of persistent and adverse activation of sympathetic outflows to the heart and kidneys in both conditions. An important goal for clinical scientists is translation of the knowledge of pathophysiology, such as this, into better treatment for patients. The achievement of this 'mechanisms to management' transition is at different stages of development with regard to the two disorders. Clinical translation is mature in cardiac failure, knowledge of cardiac neural pathophysiology having led to the introduction of beta-adrenergic blockers, an effective therapy. With essential hypertension perhaps we are on the cusp of effective translation, with recent successful testing of selective catheter-based renal sympathetic nerve ablation in patients with resistant hypertension, an intervention firmly based on the demonstration of activation of the renal sympathetic outflow. Additional evidence in this regard is provided by the results of pilot studies exploring the possibility to reduce blood pressure in resistant hypertensives through electrical stimulation of the area of carotid baroreceptors. Despite the general importance of the sympathetic nervous system in blood pressure regulation, and the specific demonstration that the blood pressure elevation in essential hypertension is commonly initiated and sustained by sympathetic nervous activation, drugs antagonizing this system are currently underutilized in the care of patients with hypertension. Use of beta-adrenergic blocking drugs is waning, given the propensity of this drug class to have adverse metabolic effects, including predisposition to diabetes development. The blood pressure lowering achieved with carotid baroreceptor stimulation and with the renal denervation device affirms the importance of the sympathetic nervous system in hypertension pathogenesis, and perhaps suggests a wider role for anti-adrenergic antihypertensives, such as the imidazoline drug class (moxonidine, rilmenidine) which act within the CNS to inhibit central sympathetic outflow, although the lack of large-scale outcome trials with this drug class remains a very material deficiency.

12 Clinical Trial Evening versus morning dosing of antihypertensive drugs in hypertensive patients with sleep apnoea: a cross-over study. 2015

Kasiakogias, Alexandros / Tsioufis, Costas / Thomopoulos, Costas / Andrikou, Ioannis / Aragiannis, Dimitrios / Dimitriadis, Kyriakos / Tsiachris, Dimitrios / Bilo, Grzegorz / Sideris, Skevos / Filis, Konstantinos / Parati, Gianfranco / Stefanadis, Christodoulos. ·aFirst Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece bDepartment of Cardiology, IRCCS Ospedale San Luca, Istituto Auxologico Italiano and Department of Health Sciences, University of Milano Bicocca, Milan, Italy cDivision of Vascular Surgery, First Department of Propaedeutic Surgery, University of Athens Medical School, Hippokration Hospital, Athens, Greece. ·J Hypertens · Pubmed #25318654.

ABSTRACT: OBJECTIVE: Beneficial effects of continuous positive airway pressure (CPAP) on both blood pressure (BP) levels and variability have been documented in patients with obstructive sleep apnoea (OSA). We investigated the relevant impact of different dosing times of antihypertensive drugs beyond CPAP application. METHODS: In this prospective, cross-over trial, we included 41 patients with newly diagnosed hypertension and never treated OSA (apnoea-hypopnea index ≥15/h), without increased daytime somnolence (Epworth Score ≤10 points). Patients first received treatment with valsartan or with a fixed combination of amlodipine and valsartan in a single morning dose for 8 weeks. In the following 8-week period, patients received the same therapeutic regimen in a single evening dose. Office and ambulatory BP were measured at baseline and after each treatment period. RESULTS: Compared with morning administration, evening dosing induced a greater decrease in office SBP (by 3.7 ± 6.5 mmHg, P = 0.001). The decrease in 24-h SBP/DBP was significant and similar after morning and evening dosing (-16.4 ± 11/11.0 ± 7.5 and -18.4 ± 11/12.1 ± 7.5 mmHg, respectively, P < 0.001 for both). Evening compared with morning dosing further reduced night-time SBP/DBP by 4.4 ± 8.6/2.9 ± 5.6 mmHg (P = 0.007 and P = 0.006, respectively). Night-time dippers increased from 24% at baseline to 34% with morning dosing and to 61% with evening dosing. There was no significant interaction between concurrent CPAP application and drugs dosing time on BP changes. CONCLUSION: Evening dosing of antihypertensive drugs improves night-time BP and dipping status in nonsleepy patients with OSA, irrespective of CPAP application.

13 Article Obstructive Sleep Apnea and Cardiovascular Disease. 2019

Perger, Elisa / Gonzaga-Carvalho, Carolina / Inami, Toru / Ryan, Clodagh M / Lyons, Owen D. ·1 Sleep Research Laboratory, University Health Network Toronto Rehabilitation Institute, Toronto, Ontario, Canada. · 2 Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada. · 3 Sleep Disorders Center, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy. · 4 Sleep Laboratory Hypertension and Nephrology Department, Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil; and. · 5 Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada. ·Am J Respir Crit Care Med · Pubmed #30433816.

ABSTRACT: -- No abstract --

14 Article Heart failure and sleep related breathing disorders: Data from PROMISES (Progetto Multicentrico Italiano Sonno e Scompenso Cardiaco) study. 2018

Lombardi, Carolina / Faini, Andrea / La Rovere, MariaTeresa / Fanfulla, Francesco / Mattaliano, Paola / Caravita, Sergio / Contini, Mauro / Agostoni, Piergiuseppe / Perrone-Filardi, Pasquale / Parati, Gianfranco / Anonymous490962. ·Sleep Disorders Center, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. Electronic address: c.lombardi@auxologico.it. · Sleep Disorders Center, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy. · Istituti Clinici Scientifici Maugeri - IRCCS Montescano, Italy. · Istituti Clinici Scientifici Maugeri - IRCCS Pavia, Italy. · Centro Cardiologico Monzino, IRCCS, Milan, Italy. · Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy. · Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy. · Sleep Disorders Center, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ·Int J Cardiol · Pubmed #30223347.

ABSTRACT: BACKGROUND: In heart failure (HF) sleep problems and sleep-related breathing disorders are frequently reported and are associated with poor prognosis. However, only few large clinical studies have investigated this issue in heart failure through breathing pattern analysis by polysomnography. METHODS AND RESULTS: 370 HF patients, with either moderate-severe reduced ejection fraction or with clinical decompensation, consecutively referred to 10 participating cardiology centers, have been enrolled in the PROMISES Study, an Italian project aimed at generating a large, multidisciplinary database of anthropometric, clinical, echocardiographic and sleep data, the last derived from overnight unattended cardio-respiratory polysomnography in HF patients. Obstructive sleep apnea was the most frequent form of sleep related breathing disorders observed in our cohort (35.4% with an AHI cutoff of 15). The possible determinants of sleep related breathing disorders were analyzed through stepwise logistic regression analysis and two multivariate models showing that a markedly reduced left ventricular ejection fraction was the most important factor associated with central sleep apneas (OR = 7.7 for AHI cutoff = 15 and LVEF ≤ 35%) together with male gender and increasing age. Conventional risk factors for obstructive sleep apnea did not identify HF patients affected by this condition. Conversely, a greater neck circumference was associated with an increased risk for central apneas. CONCLUSIONS: Our paper offers a deeper insight into the features of SRBD and its determinants in HF patients, leading in turn to a better clinical management of these comorbid patients.

15 Article Impact of obstructive sleep apnea on cardiac organ damage in patients with acute ischemic stroke. 2018

Mattaliano, Paola / Lombardi, Carolina / Sangalli, Davide / Faini, Andrea / Corrà, Barbara / Adobbati, Laura / Branzi, Giovanna / Mariani, Davide / Silani, Vincenzo / Parati, Gianfranco. ·Sleep Disorder Center, Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano. · Department of Neurology- Stroke Unit and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano. · Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano. · Department of Medicine and Surgery, University of Milano-Bicocca, Department of Cardiology, S. Luca Hospital, IRCCS Istituto Auxologico. · Department of Pathophysiology and Transplantation, 'Dino Ferrari' Centre - Università degli Studi di Milano, Milano, Italy. ·J Hypertens · Pubmed #29570509.

ABSTRACT: BACKGROUND AND PURPOSE: Both obstructive sleep apnea (OSA) and cardiac organ damage have a crucial role in acute ischemic stroke. Our aim is to explore the relationship between OSA and cardiac organ damage in acute stroke patients. METHODS: A total of 130 consecutive patients with acute ischemic stroke were enrolled. Patients underwent full multichannel 24-h polysomnography for evaluation of OSA and echocardiography to evaluate left ventricle (LV) mass index (LV mass/BSA, LV mass/height), thickness of interventricular septum (IVS) and posterior wall (LVPW), LV ejection fraction and left atrium enlargement. Information on occurrence of arterial hypertension and its treatment before stroke was obtained from patients' history. RESULTS: 61.9% (70) of patients, mostly men (67.1%), with acute stroke had OSA (AHI > 10). Patients with acute stroke and OSA showed a significant increase (P < 0.05) of LV mass index, IVS and LVPW thickness and a significant left atrial enlargement as compared with patients without OSA. LV ejection fraction was not significantly different in stroke patients with and without OSA and was within normal limits. No relationship was found among cardiac alterations, occurrence of OSA and history of hypertension. CONCLUSION: Acute stroke patients with OSA had higher LV mass and showed greater left atrial enlargement than patients without OSA. This study confirms the high prevalence of OSA in stroke patients, suggesting also an association between OSA and cardiac target organ damage. Our finding of structural LV abnormalities in acute stroke patients with OSA suggests a potential role of OSA as contributing factor in determining both cerebrovascular and cardiac damage, even in absence of clear link with a history of blood pressure elevation.

16 Article Effect of continuous positive airway pressure in hypertensive patients with obstructive sleep apnea and high urinary metanephrines. 2018

Gilardini, Luisa / Lombardi, Carolina / Redaelli, Gabriella / Mattaliano, Paola / Fanari, Paolo / Cornacchia, Mauro / Scacchi, Massimo / Mai, Stefania / Ferronato, Patrizia / Parati, Gianfranco / Invitti, Cecilia. ·Department of Medical Sciences and Rehabilitation. · Department of Cardiovascular, Neural and Metabolic Sciences, Sleep Center, S. Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan. · Pulmonary Rehabilitation Department. · Division of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Piancavallo. · Department of Clinical Sciences and Community Health, University of Milan. · Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. ·J Hypertens · Pubmed #28800040.

ABSTRACT: OBJECTIVE: Some cases of pseudopheochromocytoma have been described among hypertensive patients with obstructive sleep apnea (OSA). This study examined whether a pathological rise of urinary metanephrines is a common feature in hypertensive OSA patients and, in such a case, whether the ventilation treatment during sleep (continuous or biphasic positive airway pressure) may normalize high metanephrines levels. METHODS: Patients with endocrine diseases, drug abuse, therapy with TCA and cardiovascular events in the previous 6 months were excluded. Thirty-four hypertensive patients with OSA (BMI 40.6 ± 8.7 kg/m(2)) performed three 24-h urine collections for metanephrine assessment, before and after 1 month of ventilation therapy. RESULTS: Urinary normetanephrine (uNMT) was above the normal limit in 21 of 34 of the patients. In the 16 to 21 patients with high uNMT who were compliant to ventilation treatment, uNMT decreased in 13 by 26% and normalized in six of 13. uNMT levels were associated with apnea hypopnea index (AHI) (r = 0.799, P < 0.0001) and minimal SaO2 (r = -0.700, P < 0.01). The ventilation therapy-induced changes in AHI were associated with those in uNMT (r = 0.689, P < 0.005). In the multivariate analysis with uNMT changes as dependent variable and changes in AHI, BMI, SBP as independent variables, only AHI changes were independently associated with uNMT changes (β = 0.738, P < 0.01). CONCLUSION: Two-thirds of OSA hypertensive patients have uNMT values above the normal limit. The early identification of these patients is important as ventilation therapy can correct the pathological sympathoadrenal activation. Patients who do not normalize uNMT with ventilation therapy deserve a strict follow-up as this lack of normalization may indicate insufficient ventilation therapy or resistance of sympathetic hyperactivity to this treatment, not excluding an early stage of a chromaffin tumor.

17 Article Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure. 2017

Perger, Elisa / Inami, Toru / Lyons, Owen D / Alshaer, Hisham / Smith, Stephanie / Floras, John S / Logan, Alexander G / Arzt, Michael / Duran Cantolla, Joaquin / Delgado, Diego / Fitzpatrick, Michael / Fleetham, John / Kasai, Takatoshi / Kimoff, R John / Leung, Richard S T / Lorenzi Filho, Geraldo / Mayer, Pierre / Mielniczuk, Lisa / Morrison, Debra L / Parati, Gianfranco / Parthasarathy, Sairam / Redolfi, Stefania / Ryan, Clodagh M / Series, Frederic / Tomlinson, George A / Woo, Anna / Bradley, T Douglas / Anonymous4000924. ·University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada. · Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, Ontario, Canada. · Universitätsklinikum Regensburg, Regensburg, Germany. · Hospital Universitario Txagorritxu, Vitoria, Spain. · Queen's University, Kingston, Ontario, Canada. · Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada. · Juntendo University Hospital, Tokyo, Japan. · McGill University Health Centre, Montreal, Quebec, Canada. · St Michael's Hospital, Toronto, Ontario, Canada. · Instituto do Coração do Hospital das Clínicas da FMUSP, Sao Paulo, Brazil. · Hôpital Hôtel-Dieu du CHUM, Université de Montréal, Montreal, Quebec, Canada. · University of Ottawa Heart Institute, Ottawa, Ontario, Canada. · Capital District Health Authority, Halifax, Nova Scotia, Canada. · Ospedale San Luca, Milan, Italy. · University of Arizona College of Medicine, Tucson, Arizona. · Groupe Hospitalier Pitie-Salpetriere Charles Fox, Paris, France. · Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada. ·J Clin Sleep Med · Pubmed #29065956.

ABSTRACT: STUDY OBJECTIVES: In heart failure (HF), we observed two patterns of hyperpnea during Cheyne-Stokes respiration with central sleep apnea (CSR-CSA): a positive pattern where end-expiratory lung volume remains at or above functional residual capacity, and a negative pattern where it falls below functional residual capacity. We hypothesized the negative pattern is associated with worse HF. METHODS: Patients with HF underwent polysomnography. During CSR-CSA, hyperpnea, apnea-hyperpnea cycle, and lung to finger circulation times (LFCT) were measured. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentration and left ventricular ejection fraction (LVEF) were assessed. RESULTS: Of 33 patients with CSR-CSA (31 men, mean age 68 years), 9 had a negative hyperpnea pattern. There was no difference in age, body mass index, and apnea-hypopnea index between groups. Patients with a negative pattern had longer hyperpnea time (39.5 ± 6.4 versus 25.8 ± 5.9 seconds, CONCLUSIONS: Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function. COMMENTARY: A commentary on this article appears in this issue on page 1227. CLINICAL TRIAL REGISTRATION: The trial is registered with Current Controlled Trials (www.controlled-trials.com; ISRCTN67500535) and Clinical Trials (www.clinicaltrials.gov; NCT01128816).

18 Article Design of the effect of adaptive servo-ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT-HF trial. 2017

Lyons, Owen D / Floras, John S / Logan, Alexander G / Beanlands, Robert / Cantolla, Joaquin Durán / Fitzpatrick, Michael / Fleetham, John / John Kimoff, R / Leung, Richard S T / Lorenzi Filho, Geraldo / Mayer, Pierre / Mielniczuk, Lisa / Morrison, Debra L / Ryan, Clodagh M / Series, Frederic / Tomlinson, George A / Woo, Anna / Arzt, Michael / Parthasarathy, Sairam / Redolfi, Stefania / Kasai, Takatoshi / Parati, Gianfranco / Delgado, Diego H / Bradley, T Douglas / Anonymous500902. ·Women's College Hospital, Toronto, ON, Canada. · University Health Network/Mount Sinai Hospital, Toronto, ON, Canada. · University of Ottawa Heart Institute, Ottawa, ON, Canada. · Hospital Universitario Txagorritxu, Vitoria, Spain. · Queen's University, Kingston, ON, Canada. · Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada. · McGill University Health Centre, Montreal, QC, Canada. · St Michael's Hospital, Toronto, ON, Canada. · Instituto do Coração do Hospital das Clínicas da FMUSP, Sao Paulo, Brazil. · Hôpital Hôtel-Dieu du CHUM, Université de Montréal, Montreal, QC, Canada. · Capital District Health Authority, Halifax, NS, Canada. · Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC, Canada. · Universitätsklinikum Regensburg, Regensburg, Germany. · University of Arizona College of Medicine, Tucson, AZ, USA. · Groupe Hospitalier Pitie-Salpetriere Charles Fox, Paris, France. · Juntendo University Hospital, Tokyo, Japan. · Ospedale San Luca, Milan, Italy. ·Eur J Heart Fail · Pubmed #28371141.

ABSTRACT: INTRODUCTION: Both types of sleep-disordered breathing (SDB), obstructive and central sleep apnoea (OSA and CSA, respectively), are common in patients with heart failure and reduced ejection fraction (HFrEF). In such patients, SDB is associated with increased cardiovascular morbidity and mortality but it remains uncertain whether treating SDB by adaptive servo-ventilation (ASV) in such patients reduces morbidity and mortality. AIM: ADVENT-HF is designed to assess the effects of treating SDB with ASV on morbidity and mortality in patients with HFrEF. METHODS: ADVENT-HF is a multicentre, multinational, randomized, parallel-group, open-label trial with blinded assessment of endpoints of standard medical therapy for HFrEF alone vs. with the addition of ASV in patients with HFrEF and SDB. Patients with a history of HFrEF undergo echocardiography and polysomnography. Those with a left ventricular ejection fraction ≤45% and SDB (apnoea-hypopnoea index ≥15) are eligible. SDB is stratified into OSA with ≥50% of events obstructive or CSA with >50% of events central. Those with OSA must not have excessive daytime sleepiness (Epworth score of ≤10). Patients are then randomized to receive or not receive ASV. The primary outcome is the composite of all-cause mortality, cardiovascular hospital admissions, new-onset atrial fibrillation requiring anti-coagulation but not hospitalization, and delivery of an appropriate discharge from an implantable cardioverter-defibrillator not resulting in hospitalization during a maximum follow-up time of 5 years. CONCLUSION: The ADVENT-HF trial will help to determine whether treating SDB by ASV in patients with HFrEF improves morbidity and mortality.

19 Article Diastolic dysfunction in controlled hypertensive patients with mild-moderate obstructive sleep apnea. 2015

Lisi, Elisabetta / Faini, Andrea / Bilo, Grzegorz / Lonati, Laura Maria / Revera, Miriam / Salerno, Sabrina / Giuli, Valentina / Lombardi, Carolina / Parati, Gianfranco. ·Dept. of Health Sciences, University of Milano-Bicocca, Milan, Italy; Dept. of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. · Sleep Center, Dept. of Cardiovascular, Neural and Metabolic Diseases, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy; Dept. of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. · Dept. of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. · Sleep Center, Dept. of Cardiovascular, Neural and Metabolic Diseases, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. · Dept. of Health Sciences, University of Milano-Bicocca, Milan, Italy; Sleep Center, Dept. of Cardiovascular, Neural and Metabolic Diseases, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy; Dept. of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. Electronic address: gianfranco.parati@unimib.it. ·Int J Cardiol · Pubmed #25910471.

ABSTRACT: BACKGROUND: Hypertension and severe obstructive sleep apnea (OSA) may independently contribute to left ventricular diastolic dysfunction. However, scanty data is available on this issue in hypertensives with mild-moderate OSA. METHODS AND RESULTS: We performed polysomnography, echocardiography and 24h ambulatory blood pressure monitoring in 115 treated essential hypertensives with suspicion of OSA. After exclusion of severe/treated OSA and/or cardiovascular disease patients, mild-moderate OSA (5 ≤ apnoea/hypopnoea index<30 events·h(-1)) was diagnosed in 47.3% of the remaining 91 patients, while 52.7% were free of OSA. Transmitral early (E) and late (A) peak flow velocities were assessed in 69 patients, and mitral annular velocity (E') in 53. Compared to non-OSA, mild-moderate OSA heart rate was higher (p=0.031) while E/A was lower (p<0.001) without differences in 24h mean systolic and diastolic blood pressures (125.36 ± 12.46/76.46 ± 6.97 vs 128.63 ± 11.50/77.70 ± 7.72 mmHg, respectively, NS). Patients with E'< 10 cm/s and E/A<0.8 showed a lower mean SpO2 than subjects with normal diastolic function (p=0.004; p<0.001). In a logistic regression model age, mean SpO2, daytime heart rate and nocturnal diastolic blood pressure fall were associated with altered relaxation pattern, independently from BMI and gender. CONCLUSIONS: In controlled hypertensives mild-moderate OSA may be associated with early diastolic dysfunction, independently from age, gender and mean blood pressure and in the absence of concentric left ventricular hypertrophy. Moreover nocturnal hypoxia may be a key factor in determining early diastolic dysfunction, under the synergic effects of hypertension and mild-moderate OSA.

20 Article Nocturnal intermittent hypoxia predicts prevalent hypertension in the European Sleep Apnoea Database cohort study. 2014

Tkacova, Ruzena / McNicholas, Walter T / Javorsky, Martin / Fietze, Ingo / Sliwinski, Pawel / Parati, Gianfranco / Grote, Ludger / Hedner, Jan / Anonymous6080802. ·Dept of Respiratory Medicine, P.J. Safarik University, Medical Faculty, Kosice, Slovakia L. Pasteur University Hospital, Kosice, Slovakia. · Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, University College Dublin, Dublin, Ireland walter.mcnicholas@ucd.ie. · Schlafmedizinisches Zentrum, Charité, CCM, Berlin, Germany. · Institute of Tubercolosis and Lung Diseases, Dept of Diagnosis and Treatment of Respiratory Failure, Warsaw, Poland. · Dept of Health Sciences, University of Milano-Bicocca, Milan, Italy Dept of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. · Dept of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. ·Eur Respir J · Pubmed #25102963.

ABSTRACT: Systemic hypertension is associated with obstructive sleep apnoea syndrome (OSAS) but the pathophysiological mechanisms are incompletely understood. A collaborative European network of 24 sleep centres established a European Sleep Apnoea Database to evaluate cardiovascular morbidity associated with OSAS. 11 911 adults referred with suspected OSAS between March 2007 and September 2013 underwent overnight sleep studies, either cardiorespiratory polygraphy or polysomnography. We compared the predictive value of the apnoea-hypopnoea index (AHI) and 4% oxygen desaturation index (ODI) for prevalent hypertension, adjusting for relevant covariates including age, smoking, obesity, dyslipidaemia and diabetes. Among patients (70% male, mean±sd age 52±12 years), 78% had AHI>5 events·h(-1) and 41% systemic hypertension. Both AHI and ODI independently related to prevalent hypertension after adjustment for relevant covariates (p<0.0001 for linear trend across quartiles (Q) of severity for both variables). However, in multiple regression analysis with both ODI and AHI in the model, ODI was, whereas AHI was not, independently associated with prevalent hypertension: odds ratios (95% CI) for Q4 versus Q1 regarding ODI were 2.01 (1.61-2.51) and regarding AHI were 0.92 (0.74-1.15) (p<0.0001 and p=0.3054, respectively). This cross sectional study suggests that chronic intermittent hypoxia plays an important role in OSAS-related hypertension.

21 Article Recommendations for the management of patients with obstructive sleep apnoea and hypertension. 2013

Parati, Gianfranco / Lombardi, Carolina / Hedner, Jan / Bonsignore, Maria R / Grote, Ludger / Tkacova, Ruzena / Lévy, Patrick / Riha, Renata / Bassetti, Claudio / Narkiewicz, Krzysztof / Mancia, Giuseppe / McNicholas, Walter T / Anonymous5350749. ·Dept of Cardiology, S. Luca HospitalIstituto Auxologico Italiano IRCSS, PiaMilan, Italy. gianfranco.parati@unimib.it ·Eur Respir J · Pubmed #23397300.

ABSTRACT: This article is aimed at addressing the current state-of-the-art in epidemiology, pathophysiology, diagnostic procedures and treatment options for appropriate management of obstructive sleep apnoea (OSA) in cardiovascular (in particular hypertensive) patients, as well as for the management of cardiovascular diseases (in particular arterial hypertension) in OSA patients. The present document is the result of work performed by a panel of experts participating in the European Union COST (Cooperation in Scientific and Technological research) Action B26 on OSA, with the endorsement of the European Respiratory Society and the European Society of Hypertension. In particular, these recommendations are aimed at reminding cardiovascular experts to consider the occurrence of sleep-related breathing disorders in patients with high blood pressure. They are also aimed at reminding respiration experts to consider the occurrence of hypertension in patients with respiratory problems at night.

22 Article High-altitude hypoxia and periodic breathing during sleep: gender-related differences. 2013

Lombardi, Carolina / Meriggi, Paolo / Agostoni, Piergiuseppe / Faini, Andrea / Bilo, Grzegorz / Revera, Miriam / Caldara, Gianluca / Di Rienzo, Marco / Castiglioni, Paolo / Maurizio, Bussotti / Gregorini, Francesca / Mancia, Giuseppe / Parati, Gianfranco / Anonymous3730746. ·Department of Cardiology, S.Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy. ·J Sleep Res · Pubmed #23294420.

ABSTRACT: High-altitude exposure is characterized by the appearance of periodic breathing during sleep. Only limited evidence is available, however, on the presence of gender-related differences in this breathing pattern. In 37 healthy subjects, 23 male and 14 female, we performed nocturnal cardio-respiratory monitoring in the following conditions: (1) sea level; (2) first/second night at an altitude of 3400 m; (3) first/second night at an altitude of 5400 m and after a 10 day sojourn at 5400 m. At sea level, a normal breathing pattern was observed in all subjects throughout the night. At 3400 m the apnea-hypopnea index was 40.3 ± 33.0 in males (central apneas 77.6%, central hypopneas 22.4%) and 2.4 ± 2.8 in females (central apneas 58.2%, central hypopneas 41.8%; P < 0.01). During the first recording at 5400 m, the apnea-hypopnea index was 87.5 ± 35.7 in males (central apneas 60.0%, central hypopneas 40.0%) and 41.1 ± 44.0 in females (central apneas 73.2%, central hypopneas 26.8%; P < 0.01), again with a higher frequency of central events in males as seen at lower altitude. Similar results were observed after 10 days. With increasing altitude, there was also a progressive reduction in respiratory cycle length during central apneas in males (26.9 ± 3.4 s at 3400 m and 22.6 ± 3.7 s at 5400 m). Females, who displayed a significant number of central apneas only at the highest reached altitude, were characterized by longer cycle length than males at similar altitude (30.1 ± 5.8 s at 5400 m). In conclusion, at high altitude, nocturnal periodic breathing affects males more than females. Females started to present a significant number of central sleep apneas only at the highest reached altitude. After 10 days at 5400 m gender differences in the apnea-hypopnea index similar to those observed after acute exposure were still observed, accompanied by differences in respiratory cycle length.