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Sleep Apnea Syndromes: HELP
Articles from Crete
Based on 42 articles published since 2009
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These are the 42 published articles about Sleep Apnea Syndromes that originated from Crete during 2009-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Insomnia and excessive daytime sleepiness in obstructive sleep apnea: only different clinical phenotypes? 2015

Mermigkis, Charalampos / Bouloukaki, Izolde / Schiza, Sophia E. ·Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Crete, Greece. mermigh@gmail.com. · Sleep Disorders Center, 401 General Army Hospital, Thrakis 61A, Vrilissia, Athens, Greece. mermigh@gmail.com. · Sleep Disorders Center, Henry Dunant Hospital, Athens, Greece. mermigh@gmail.com. · Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Crete, Greece. ·Sleep Breath · Pubmed #25855472.

ABSTRACT: -- No abstract --

2 Editorial Expiratory positive airway pressure (EPAP) nasal device therapy: a welcome addition to obstructive sleep apnea syndrome therapy. 2015

Schiza, Sophia E / Mermigkis, Charalampos / Bouloukaki, Izolde. ·Sleep Disorders Center, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, 711 10, Heraklion, Crete, Greece, schiza@med.uoc.gr. ·Sleep Breath · Pubmed #25847320.

ABSTRACT: -- No abstract --

3 Editorial Leptin and leptin receptor gene polymorphisms and obstructive sleep apnea syndrome: is there an association? 2015

Schiza, Sophia E / Mermigkis, Charalampos / Bouloukaki, Izolde. ·Sleep Disorders Center, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, 71110, Heraklion, Crete, Greece, schiza@med.uoc.gr. ·Sleep Breath · Pubmed #25666382.

ABSTRACT: -- No abstract --

4 Editorial Cost-effectiveness of CPAP treatment related to cardiovascular disease in patients with severe OSAS: the Greek experience. 2015

Mermigkis, Charalampos / Bouloukaki, Izolde / Schiza, Sophia E. ·Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Thrakis 61A, Vrilissia, Athens, Greece, mermigh@gmail.com. ·Sleep Breath · Pubmed #25304123.

ABSTRACT: -- No abstract --

5 Editorial Implications of revised AASM rules on scoring apneic and hypopneic respiratory events in heart failure patients with nocturnal Cheyne-Stokes respiration. 2015

Schiza, Sophia E / Mermigkis, Charalampos / Bouloukaki, Izolde. ·Sleep Disorders Center, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Crete, 71110, Greece, schiza@med.uoc.gr. ·Sleep Breath · Pubmed #25060193.

ABSTRACT: -- No abstract --

6 Editorial The influence of a clinical classification system on the management of patients with positional dependent obstructive sleep apnoea. 2015

Schiza, Sophia E / Mermigkis, Charalampos / Bouloukaki, Izolde. ·Sleep Disorders Center, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, 71110, Heraklion, Crete, Greece, schiza@med.uoc.gr. ·Sleep Breath · Pubmed #25023523.

ABSTRACT: -- No abstract --

7 Editorial The effect of obstructive sleep apnea syndrome and snoring severity to intima-media thickening of carotid artery. 2015

Schiza, Sophia E / Mermigkis, Charalampos / Bouloukaki, Izolde. ·Sleep Disorders Center, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, 71110, Heraklion Crete, Greece, schiza@med.uoc.gr. ·Sleep Breath · Pubmed #24925821.

ABSTRACT: -- No abstract --

8 Editorial The effect of weight loss on obstructive sleep apnea (OSA) severity and position dependence in the bariatric population. 2014

Schiza, Sophia E / Mermigkis, Charalampos / Bouloukaki, Izolde. ·Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, 71110, Heraklion, Crete, Greece, schiza@med.uoc.gr. ·Sleep Breath · Pubmed #24638264.

ABSTRACT: -- No abstract --

9 Editorial Epworth sleepiness scale scores and adverse pregnancy outcomes. 2013

Schiza, Sophia E / Bouloukaki, Izolde / Mermigkis, Charalampos. ·Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Crete, Greece, schiza@med.uoc.gr. ·Sleep Breath · Pubmed #23483324.

ABSTRACT: -- No abstract --

10 Review Sleep as a New Target for Improving Outcomes in Idiopathic Pulmonary Fibrosis. 2017

Mermigkis, Charalampos / Bouloukaki, Izolde / Schiza, Sophia E. ·Sleep Disorders Center, Henry Dunant Hospital, Athens; Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece. Electronic address: mermigh@gmail.com. · Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece. ·Chest · Pubmed #28774636.

ABSTRACT: Idiopathic pulmonary fibrosis (IPF) is the most common type of interstitial pneumonia but remains a disease with a poor outcome. Two drugs, pirfenidone and nintedanib, have shown promising results at stalling disease progression; however, the interplay of sleep disruption or sleep disorders overall and in relation to medication effectiveness remains understudied. In the past, there was limited interest in the role of sleep in patients with IPF. Treating physicians tended to address only the daily disabling symptoms while disregarding the possible significant role of sleep alterations or coexisting sleep disorders. During the past few years, there has been more research related to sleep disturbances in patients with IPF and their possible role in sleep and overall life quality, disease progression, and outcome. In summary, sleep in patients with IPF is significantly impaired, with alterations in sleep architecture, changes in sleep breathing pattern, and decreases in oxygen saturation mainly during vulnerable rapid eye movement sleep. There also is evidence that OSA has an increased prevalence in these patients, playing an important role in the already worse sleep quality related to the disease itself. The focus of this review is not only to present current data related to sleep in patients with IPF but also to point out that therapy for sleep problems and OSA is likely to improve sleep and life quality as well as disease outcome. The main priority remains to increase awareness among treating physicians about early diagnosis of OSA in patients with IPF and to emphasize the need for intense future research, especially on the role of intermittent hypoxia superimposed on chronic hypoxia during sleep in patients with IPF.

11 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.

12 Review Obesity and atrial fibrillation: A comprehensive review of the pathophysiological mechanisms and links. 2015

Goudis, Christos A / Korantzopoulos, Panagiotis / Ntalas, Ioannis V / Kallergis, Eleftherios M / Ketikoglou, Dimitrios G. ·Department of Cardiology, General Hospital of Grevena, Grevena, Greece. · First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece. Electronic address: p.korantzopoulos@yahoo.gr. · First Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece. · Department of Cardiology, University Hospital of Heraklion, Heraklion, Greece. · Department of Cardiology, Interbalkan Medical Center, Thessaloniki, Greece. ·J Cardiol · Pubmed #25959929.

ABSTRACT: Obesity is a worldwide health problem with epidemic proportions that has been associated with atrial fibrillation (AF). Even though the underlying pathophysiological mechanisms have not been completely elucidated, several experimental and clinical studies implicate obesity in the initiation and perpetuation of AF. Of note, hypertension, diabetes mellitus, metabolic syndrome, coronary artery disease, and obstructive sleep apnea, represent clinical correlates between obesity and AF. In addition, ventricular adaptation, diastolic dysfunction, and epicardial adipose tissue appear to be implicated in atrial electrical and structural remodeling, thereby promoting the arrhythmia in obese subjects. The present article provides a concise overview of the association between obesity and AF, and highlights the underlying pathophysiological mechanisms.

13 Clinical Trial Obstructive sleep apnea should be treated in patients with idiopathic pulmonary fibrosis. 2015

Mermigkis, Charalampos / Bouloukaki, Izolde / Antoniou, Katerina / Papadogiannis, Georgios / Giannarakis, Ioannis / Varouchakis, Georgios / Siafakas, Nikolaos / Schiza, Sophia E. ·Sleep Disorders Unit, Department of Thoracic Medicine, University General Hospital, Medical School of the University of Crete, Heraklion, Greece, mermigh@gmail.com. ·Sleep Breath · Pubmed #25028171.

ABSTRACT: STUDY OBJECTIVES: The most recent idiopathic pulmonary fibrosis (IPF) guidelines include obstructive sleep apnea (OSA) among the IPF-associated comorbidities. Furthermore, they recognize the paucity of studies related to continuous positive airway pressure(CPAP) treatment in this patient group and call for intensive research in this field. Our aim was to assess the effect of CPAP treatment on sleep and overall life quality parameters, morbidity, and mortality in IPF patients with OSA. METHODS: Ninety-two treatment-naive, newly diagnosed, consecutive IPF patients underwent overnight-attended polysomnography (PSG). In those patients with an apnea-hypopnea index (AHI) of ≥15, therapy with CPAP was initiated. Patients were divided into poor and good CPAP compliance groups. All subjects completed multiple quality-of-life and sleep instruments before CPAP initiation and at 1 year after the start of CPAP treatment. RESULTS: The good CPAP compliance group (37 patients) showed statistically significant improvement in all quality-of-life and sleep instruments after 1 year's CPAP treatment. The poor CPAP compliance group (18 patients) showed significant changes of smaller strength only in a minority of the used instruments. During the 24-month follow-up period after CPAP initiation, three patients from the CPAP poor compliance group died, whereas all patients from the good CPAP compliance group remained alive. CONCLUSION: Early OSA recognition and treatment is crucial in a fatal disease such as IPF. Effective CPAP treatment in IPF patients with OSA results in a significant improvement in daily living activities and quality of sleep and life. Good CPAP compliance appears to improve mortality.

14 Clinical Trial Translation and validation of Berlin questionnaire in primary health care in Greece. 2013

Bouloukaki, Izolde / Komninos, Ioannis D / Mermigkis, Charalampos / Micheli, Katerina / Komninou, Maria / Moniaki, Violeta / Mauroudi, Eleni / Siafakas, Nikolaos M / Schiza, Sophia E. ·Department of Thoracic Medicine, Sleep Disorders Unit, University of Crete, Heraklion, Crete, Greece. izolthi@gmail.com ·BMC Pulm Med · Pubmed #23347772.

ABSTRACT: BACKGROUND: The aim of our study was to validate a Greek translation of the Berlin Questionnaire (BQ) for obstructive sleep apnoea syndrome (OSAS) and to explore whether this screening questionnaire could be used to help identify primary care patients at greater risk of having OSAS. METHODS: We recruited 189 patients visiting a primary health care setting on the island of Crete, Greece. They all completed the Greek Version of the BQ. Patients were then referred to a Sleep Disorders Unit for evaluation of suspected sleep-disordered breathing. RESULTS: A PSG study was performed in 129 of the 189 subjects (68.3%). BQ identified 74.4% (n = 96) of the patients as high-risk for OSAS and the remaining 25.6% (n = 33) as low-risk. The sensitivity and specificity of BQ for OSAS diagnosis were 76% and 40%, respectively, for an apnoea-hypopnoea index (AHI) ≥5 per hour but <15 per hour, 84% and 61% for an AHI ≥15 per hour but ≤30 per hour, and 79% and 39% for an AHI >30 per hour. CONCLUSIONS: In conclusion, the Greek Version of the BQ is a useful instrument for identifying patients at risk for OSAS in primary health care in Greece. The findings of our study confirm that such screening tools should be used by primary care clinicians for OSAS prediction.

15 Article The Association Between Adherence to Positive Airway Pressure Therapy and Long-Term Outcomes in Patients With Obesity Hypoventilation Syndrome: A Prospective Observational Study. 2018

Bouloukaki, Izolde / Mermigkis, Charalampos / Michelakis, Stylianos / Moniaki, Violeta / Mauroudi, Eleni / Tzanakis, Nikolaos / Schiza, Sophia E. ·Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece. ·J Clin Sleep Med · Pubmed #30176976.

ABSTRACT: STUDY OBJECTIVES: To assess the role of different levels of adherence and long-term effects of positive airway pressure (PAP) therapy on gas exchange, sleepiness, quality of life, depressive symptoms, and all-cause mortality in patients with obesity hypoventilation syndrome (OHS). METHODS: A total of 252 patients with newly diagnosed OHS were followed up for a minimum of 2 years after PAP initiation. PAP adherence (h/night) was monitored. Arterial blood gas samples were taken with patients being alert for more than 4 hours after morning awakening. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]), quality of life (Short Form 36 [SF-36]) and patient's depressive symptoms (Beck Depression Inventory [BDI]) were assessed before and at the end of the follow-up period, along with all-cause mortality. RESULTS: At the end of the follow-up period (median duration [25th-75th percentile], 30 [24-52] months), PaO CONCLUSIONS: Increased hours of use and long-term therapy with PAP are effective in the treatment of patients with OHS. Clinicians should encourage adherence to PAP therapy in order to provide a significant improvement in clinical status and gas exchange in these patients. COMMENTARY: A commenary on this article appears in this issue on page 1455. CLINICAL TRIAL REGISTRATION: Title: PAP Therapy in Patients With Obesity Hypoventilation Syndrome, Registry: ClinicalTrials.gov, Identifier: NCT03449641, URL: https://clinicaltrials.gov/ct2/show/NCT03449641.

16 Article Clinical presentation of patients with suspected obstructive sleep apnea and self-reported physician-diagnosed asthma in the ESADA cohort. 2018

Bonsignore, Maria R / Pepin, Jean-Louis / Anttalainen, Ulla / Schiza, Sophia E / Basoglu, Ozen K / Pataka, Athanasia / Steiropoulos, Paschalis / Dogas, Zoran / Grote, Ludger / Hedner, Jan / McNicholas, Walter T / Marrone, Oreste / Anonymous1981538. ·Biomedical Department of Internal and Specialistic Medicine (DIBIMIS), University of Palermo, Palermo, Italy. · CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy. · Université Grenoble Alpes, INSERM U1042, CHU de Grenoble, Grenoble, France. · Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland. · Department of Physiology, Sleep Research Centre, University of Turku, Turku, Finland. · Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece. · Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey. · Department of Respiratory Medicine, G. Papanikolaou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece. · Sleep Unit, Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece. · Split Sleep Medicine Center and Department of Neuroscience, University of Split School of Medicine, Split, Croatia. · Department of Sleep Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. · Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. · Department of Respiratory and Sleep Medicine, St. Vincent's University Hospital, Dublin, Ireland. · Conway Research Institute, University College Dublin, Dublin, Ireland. ·J Sleep Res · Pubmed #29998568.

ABSTRACT: Obstructive sleep apnea (OSA) and asthma are often associated and several studies suggest a bidirectional relationship between asthma and OSA. This study analyzed the characteristics of patients with suspected OSA from the European Sleep Apnea Database according to presence/absence of physician-diagnosed asthma. Cross-sectional data in 16,236 patients (29.1% female) referred for suspected OSA were analyzed according to occurrence of physician-diagnosed asthma for anthropometrics, OSA severity and sleepiness. Sleep structure was assessed in patients studied by polysomnography (i.e. 48% of the sample). The prevalence of physician-diagnosed asthma in the entire cohort was 4.8% (7.9% in women, 3.7% in men, p < 0.0001), and decreased from subjects without OSA to patients with mild-moderate and severe OSA (p = 0.02). Obesity was highly prevalent in asthmatic women, whereas BMI distribution was similar in men with and without physician-diagnosed asthma. Distribution of OSA severity was similar in patients with and without physician-diagnosed asthma, and unaffected by treatment for asthma or gastroesophageal reflux. Asthma was associated with poor sleep quality and sleepiness. Physician-diagnosed asthma was less common in a sleep clinic population than expected from the results of studies in the general population. Obesity appears as the major factor raising suspicion of OSA in asthmatic women, whereas complaints of poor sleep quality were the likely reason for referral in asthmatic men.

17 Article Change in weight and central obesity by positive airway pressure treatment in obstructive sleep apnea patients: longitudinal data from the ESADA cohort. 2018

Basoglu, Ozen K / Zou, Ding / Tasbakan, Mehmet S / Hedner, Jan / Ryan, Silke / Verbraecken, Johan / Escourrou, Pierre / Antalainen, Ulla / Kvamme, John A / Bonsignore, Maria R / Schiza, Sofia / Grote, Ludger / Anonymous1851538. ·Department of Chest Diseases, Ege University, Izmir, Turkey. · Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. · Sleep Disorders Center, Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. · Department of Respiratory Medicine, St Vincent's University Hospital, University College Dublin, School of Medicine, Dublin, Ireland. · Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium. · Service dÉxplorations Fonctionnelles Multidisciplinaires Hospital Antoine Beclere, Clamart, France. · Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital and Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland. · Sleep Laboratory, ENT Department, Førde Central Hospital, Førde, Norway. · Biomedical Department of Internal and Specialistic Medicine (DiBiMIS), Section of Pneumology, University of Palermo and CNR Institute of Biomedicine and Molecular Immunology, Palermo, Italy. · Department of Thoracic Medicine, Sleep Disorders Center, University of Crete, Heraklion, Greece. ·J Sleep Res · Pubmed #29797754.

ABSTRACT: The effect of positive airway pressure treatment on weight and markers of central obesity in patients with obstructive sleep apnea remains unclear. We studied the change in body weight and anthropometric measures following positive airway pressure treatment in a large clinical cohort. Patients with obstructive sleep apnea with positive airway pressure treatment from the European Sleep Apnea Database registry (n = 1,415, 77% male, age 54 ± 11 [mean ± SD] years, body mass index 31.7 ± 6.4 kg/m

18 Article Evaluation of Inflammatory Markers in a Large Sample of Obstructive Sleep Apnea Patients without Comorbidities. 2017

Bouloukaki, Izolde / Mermigkis, Charalampos / Tzanakis, Nikolaos / Kallergis, Eleftherios / Moniaki, Violeta / Mauroudi, Eleni / Schiza, Sophia E. ·Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece. ·Mediators Inflamm · Pubmed #28831208.

ABSTRACT: Systemic inflammation is important in obstructive sleep apnea (OSA) pathophysiology and its comorbidity. We aimed to assess the levels of inflammatory biomarkers in a large sample of OSA patients and to investigate any correlation between these biomarkers with clinical and polysomnographic (PSG) parameters. This was a cross-sectional study in which 2983 patients who had undergone a polysomnography for OSA diagnosis were recruited. Patients with known comorbidities were excluded. Included patients (

19 Article The role of compliance with PAP use on blood pressure in patients with obstructive sleep apnea: is longer use a key-factor? 2017

Bouloukaki, I / Mermigkis, C / Tzanakis, N / Giannadaki, K / Mauroudi, E / Moniaki, V / Kallergis, E M / Schiza, S E. ·Department of Thoracic Medicine, Sleep Disorders Center, University of Crete, Heraklion, Greece. ·J Hum Hypertens · Pubmed #27465978.

ABSTRACT: Scientific data about the effects of positive airway pressure (PAP) treatment on blood pressure (BP) control are continuously increasing; however, they are controversial. We aimed to determine the long-term effects of compliance with PAP therapy on BP in both hypertensive and normotensive patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). One thousand one hundred sixty eight consecutive patients with newly diagnosed OSAHS, who had been recommended PAP therapy, were followed up for a minimum of 2 years. Patients with previous cardiovascular disease were excluded. BP was measured at baseline and after 2 years of PAP treatment. In addition, the correlation between the changes in BP with different levels of PAP compliance was assessed. At the end of the follow-up period, in the hypertensive group of patients (n=586), a significant decrease was shown in systolic (-11.2 mm Hg, P<0.001) and diastolic BP (-4.2 mm Hg, P<0.001). Furthermore, in the patients without hypertension (n=528), a significant decrease was noted both in systolic and diastolic BP (-3.6, P<0.001 and -2.4, P<0.001, respectively). A correlation between the magnitude of change in systolic and diastolic BP and hours of use of PAP (r=0.14, P=0.002 and r=0.1, P=0.025, respectively) was observed in all patients. Long-term use of PAP treatment, as well as increased hours of PAP in patients with OSAHS use showed significant reductions in BP not only in patients with hypertension, but also in normotensive patients. Therefore a significant potential reduction in cardiovascular mortality and morbidity should be expected in these patients.

20 Article Sleep apnoea and the hypothalamic-pituitary-adrenal axis in men and women: effects of continuous positive airway pressure. 2016

Kritikou, Ilia / Basta, Maria / Vgontzas, Alexandros N / Pejovic, Slobodanka / Fernandez-Mendoza, Julio / Liao, Duanping / Bixler, Edward O / Gaines, Jordan / Chrousos, George P. ·Sleep Research and Treatment Center, Dept of Psychiatry, Pennsylvania State University, College of Medicine, Hershey, PA, USA. · Sleep Research and Treatment Center, Dept of Psychiatry, Pennsylvania State University, College of Medicine, Hershey, PA, USA Dept of Psychiatry, University of Crete School of Medicine, Heraklion, Greece. · Sleep Research and Treatment Center, Dept of Psychiatry, Pennsylvania State University, College of Medicine, Hershey, PA, USA avgontzas@hmc.psu.edu. · Dept of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA. · First Dept of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece. ·Eur Respir J · Pubmed #26541531.

ABSTRACT: Previous findings on the association of obstructive sleep apnoea (OSA) and the hypothalamic-pituitary-adrenal (HPA) axis are inconsistent, partly due to the confounding effect of obesity and infrequent sampling. Our goal was to examine whether in a relatively nonobese population, OSA is associated with elevated cortisol levels and to assess the effects of a 2-month placebo-controlled continuous positive airway pressure (sham-CPAP) use.72 subjects (35 middle-aged males and post-menopausal females with OSA, and 37 male and female controls) were studied in the sleep laboratory for four nights. 24-h blood sampling was performed every hour on the fourth day and night in the sleep laboratory at baseline, after sham-CPAP and after CPAP treatment.In both apnoeic men and women, OSA was associated with significantly higher 24-h cortisol levels compared with controls, whereas CPAP lowered cortisol levels significantly, close to those of controls.These results suggest that OSA in nonobese men and slightly obese women is associated with HPA axis activation, similar albeit stronger compared with obese individuals with sleep apnoea. Short-term CPAP use decreased cortisol levels significantly compared with baseline, indicating that CPAP may have a protective effect against comorbidities frequently associated with chronic activation of the HPA axis, e.g. hypertension.

21 Article Chronic fatigue syndrome and fibromyalgia in diagnosed sleep disorders: a further test of the 'unitary' hypothesis. 2015

Pejovic, Slobodanka / Natelson, Benjamin H / Basta, Maria / Fernandez-Mendoza, Julio / Mahr, Fauzia / Vgontzas, Alexandros N. ·Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA. bobapejovic@gmail.com. · Department of Neurology, Pain and Fatigue Study Center, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, 10003, USA. bnatelson@bethisraelny.org. · Department of Psychiatry, School of Medicine, University of Crete, Iraklion, Greece. mbasta@med.uoc.gr. · Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA. jfernandezmendoza@hmc.psu.edu. · Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA. fmahr@hmc.psu.edu. · Department of Psychiatry, Sleep Research and Treatment Center, Penn State College of Medicine, Hershey, PA, 17033, USA. axv3@psu.edu. ·BMC Neurol · Pubmed #25884538.

ABSTRACT: BACKGROUND: Since chronic fatigue syndrome (CFS) and fibromyalgia (FM) often co-exist, some believe they reflect the same process, somatization. Against that hypothesis are data suggesting FM but not CFS was common in patients with sleep-disordered breathing (SDB). The presence of discrete case definitions for CFS and FM allowed us to explore rates of CFS alone, CFS with FM, and FM alone in SDB patients compared to those with sleep complaints that fulfilled criteria for insomnia. METHODS: Participants were 175 sequential patients with sleep-related symptoms (122 had SDB and 21 had insomnia) and 39 healthy controls. Diagnoses were made by questionnaires, tender point count, and rule out labs; sleepiness was assessed with Epworth Sleepiness Scale and mood with Beck Depression Inventory. RESULTS: Rates of CFS, FM or CFS + FM were high: 13% in SDB and 48% in insomnia. CFS occurred frequently in SDB and insomnia, but FM occurred frequently only in insomnia. SDB patients with CFS and/or FM had higher daytime sleepiness than those without these disorders. CONCLUSION: CFS patients should complete Epworth scales, and sleep evaluation should be considered for those with scores ≥ 16 before receiving the diagnosis of CFS; the coexistence of depressed mood in these patients suggests some may be helped by treatment of their depression. That FM was underrepresented in SDB suggests FM and CFS may have different underlying pathophysiological causes.

22 Article Gender differences in the association of sleep apnea and inflammation. 2015

Gaines, Jordan / Vgontzas, Alexandros N / Fernandez-Mendoza, Julio / Kritikou, Ilia / Basta, Maria / Bixler, Edward O. ·Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA. · Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA. Electronic address: avgontzas@psu.edu. · Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Crete, Greece. ·Brain Behav Immun · Pubmed #25535861.

ABSTRACT: Over the last 15years, many studies have established an association of sleep apnea with inflammation and metabolic aberrations. However, no controlled studies have examined potential gender effects in this association. We recruited 120 middle-aged, predominantly non-obese mild-to-moderate sleep apneics and controls (62 males, 58 females). All participants underwent a clinical history, physical examination, and 1-night 8-h polysomnography recording and provided a single fasting blood sample for assessment of interleukin-6 (IL-6), tumor necrosis factor receptor 1 (TNFR1), C-reactive protein (CRP), leptin, and adiponectin levels. Among non-sleep apneics, females had higher levels of TNFR1 (p=0.01), CRP (p=0.005), leptin (p<0.001), and adiponectin (p<0.001) compared to males, independent of age and body mass index. When analyzed separately by gender, sleep apneic men had elevated TNFR1 (p=0.04), CRP (p=0.06) and IL-6 (p=0.11) relative to control men; in sleep apneic females, only CRP was elevated (p=0.04). Furthermore, CRP was associated with apnea severity in a dose-response manner (p-linear=0.04 in both genders) and was independently associated with comorbid hypertension in apnea (p-linear=0.005 for women; p-linear=0.09 for men). In conclusion, although women have naturally higher levels of inflammatory and metabolic markers than men, sleep apneic men appear to have a more severe inflammatory profile compared to women. Our findings suggest that these markers should be analyzed and interpreted separately in men and women, and that a single measure of plasma CRP appears to be a clinically-useful marker of apnea severity and comorbid cardiovascular morbidity.

23 Article The prevalence of obstructive sleep apnea-hypopnea syndrome-related symptoms and their relation to airflow limitation in an elderly population receiving home care. 2014

Kleisiaris, Christos F / Kritsotakis, Evangelos I / Daniil, Zoe / Tzanakis, Nikolaos / Papaioannou, Agelos / Gourgoulianis, Konstantinos I. ·Department of Nursing, Technological Educational Institute of Crete, Heraklion, Greece. · School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, England. · Respiratory Medicine Department, Medical School, University of Thessaly, Larissa, Greece. · Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece. · Department of Medical Laboratories, Technological Educational Institute of Thessaly, Larissa, Greece. ·Int J Chron Obstruct Pulmon Dis · Pubmed #25336942.

ABSTRACT: BACKGROUND: Both airflow limitation and obstructive sleep apnea-hypopnea syndrome (OSAHS)-related symptoms are most prevalent in the elderly population. Previous studies revealed significant associations between OSAHS-related symptoms and obstructive airway diseases in the general population. However, other studies showed that the frequency of OSAHS-related symptoms in patients with obstructive airway diseases decreases after the age of 60 and older. AIMS: To investigate the prevalence of OSAHS-related symptoms (snoring, breathing pauses, and excessive daytime sleepiness [EDS]) and their relations to airflow limitation, for people over 65 years old. METHODS: A full screening spirometry program was performed in a total of 490 aging participants (mean age 77.5 years - range 65-98) who were attending 16 home care settings in central Greece. Airflow limitation was assessed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric criteria (FEV1/FVC <70%). The Berlin Questionnaire and the Epworth Sleepiness Scale were used to screen individuals for OSAHS-related symptoms. Bivariate associations were described using odds ratio (OR) with 95% confidence intervals (CI). RESULTS: Airflow limitation prevalence was 17.1% (male 24.2% and female 9.9%) and was strongly related to male gender and smoking status. The prevalence rates of frequent snoring, breathing pauses, and EDS were 28.1%, 12.9%, and 11.6%, respectively. However, participants with airflow limitation were less likely to report breathing pauses, frequent snoring, EDS, and obesity. Finally, frequent snoring was significantly more common in males than females. CONCLUSION: This study revealed decreased frequency of OSAHS-related symptoms in participants with airflow limitation suggesting that OSAHS-related symptoms and airflow limitation are not related in our elderly population.

24 Article Intensive versus standard follow-up to improve continuous positive airway pressure compliance. 2014

Bouloukaki, Izolde / Giannadaki, Katerina / Mermigkis, Charalampos / Tzanakis, Nikolaos / Mauroudi, Eleni / Moniaki, Violeta / Michelakis, Stylianos / Siafakas, Nikolaos M / Schiza, Sophia E. ·Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece izolthi@gmail.com. · Sleep Disorders Center, Dept of Thoracic Medicine, University of Crete, Heraklion, Crete, Greece. ·Eur Respir J · Pubmed #24993911.

ABSTRACT: We aimed to compare the effect of intensive versus standard interventions on continuous positive airway pressure (CPAP) adherence 2 years after CPAP initiation, as well as on sleepiness, quality of life, depression, hospitalisation and death rate due to cardiovascular disease (CVD). 3100 patients with newly diagnosed sleep apnoea were randomised into the standard group, with usual follow-up care, or the intensive group, with additional visits, telephone calls and education. Subjective daytime sleepiness (Epworth Sleepiness Scale; ESS), quality of life (36-item Short Form Health Survey; SF-36) and the patient's level of depression (Beck Depression Inventory; BDI) were recorded before and 2 years after CPAP initiation, together with CVD hospitalisations and death rate. 2 years after CPAP initiation, the intensive group used CPAP significantly more than the standard group (6.9 versus 5.2 h per night; p<0.001). ESS, SF-36 and BDI scores were also significantly better in the intensive group. Furthermore, the standard group had significantly more deaths and hospitalisations due to CVD. CPAP usage can be improved by both intensive and standard patient support. However, the patients who received intensive CPAP support had significantly better ESS, BDI and SF-36 scores, and lower cardiovascular morbidity and mortality, suggesting that an intensive programme could be worthwhile.

25 Article Abnormal cytokine profile in patients with obstructive sleep apnea-hypopnea syndrome and erectile dysfunction. 2014

Bouloukaki, Izolde / Papadimitriou, Vaios / Sofras, Frank / Mermigkis, Charalampos / Moniaki, Violeta / Siafakas, Nikolaos M / Schiza, Sophia E. ·Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, 711 10 Heraklion, Crete, Greece. · Department of Urology, University of Crete, 711 10 Heraklion, Crete, Greece. ·Mediators Inflamm · Pubmed #24966468.

ABSTRACT: Patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) show a high prevalence of erectile dysfunction (ED). Although the underlying pathogenesis is still unknown, endothelial dysfunction, induced by inflammatory cytokines, chemokines, and adhesion molecules, has been proposed as a possible mechanism. The aim of this study was to assess whether OSAHS is associated with activation of the inflammatory cytokine system in patients with ED compared to the matched OSAHS patients with normal sexual function. Thirty-one patients with severe OSAHS and ED were included. Fifteen patients with severe OSAHS and without ED served as controls. Serum concentrations of high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-a), interleukin-6 (IL-6), interleukin-8 (IL-8), and adiponectin were measured after the diagnostic polysomnography. We found that hsCRP levels were significantly elevated in OSAHS patients with ED compared to controls. Similarly, TNF-a levels, IL-6, and IL-8 were elevated in OSAHS patients with ED compared to controls. Serum adiponectin levels were lower in OSAHS-ED patients, but the difference did not reach statistical significance. The presence of ED in patients with severe OSAHS is associated with elevated levels of inflammatory markers, underlining a possible involvement of endothelial dysfunction in the pathogenesis of ED.

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