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Oscullo G, Gomez-Olivas JD, Martínez-García MÁ. Obstructive sleep apnoea in the elderly: a significant problem that needs urgent attention. Int J Tuberc Lung Dis 2023; 27:715-717. [PMID: 37749843 PMCID: PMC10519383 DOI: 10.5588/ijtld.23.0332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- G Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia
| | - J D Gomez-Olivas
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia
| | - M Á Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Centro de InvestigaciÓn Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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Martinez-Garcia MA, Oscullo G, Gomez-Olivas JD. Reply to letter to the editor: understanding sleep apnea in older adults. Sleep Med 2022; 92:103-104. [PMID: 35248472 DOI: 10.1016/j.sleep.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Affiliation(s)
- M A Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBER Enfermedades Respiratorias (CIBERES). Madrid. Spain.
| | - G Oscullo
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J D Gomez-Olivas
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Martinez-Garcia MA, Oscullo G, Ponce S, Pastor E, Orosa B, Catalán P, Martinez A, Hernandez L, Muriel A, Chiner E, Vigil L, Carmona C, Mayos M, Garcia-Ortega A, Gomez-Olivas JD, Beauperthuy T, Bekki A, Gozal D. Effect of continuous positive airway pressure in very elderly with moderate-to-severe obstructive sleep apnea pooled results from two multicenter randomized controlled trials. Sleep Med 2021; 89:71-77. [PMID: 34915264 DOI: 10.1016/j.sleep.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/31/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE There is very limited information about the effect of continuous positive airway pressure (CPAP) in the very elderly. Here we aimed to analysed the effect of CPAP on a clinical cohort of patients with obstructive sleep apnea (OSA) ≥80 years old. METHODS Post-hoc pooled analysis of two open-label, multicenter clinical trials aimed to determine the effect of CPAP in a consecutive clinical cohort of elderly (≥70 years old) with moderate-to-severe OSA (apnea-hipopnea index ≥15 events/hour) randomized to receive CPAP or no CPAP for three months. Those consecutive patients ≥80 years old were included in the study. The primary endpoint was the change in Epworth Sleepiness scale (ESS). Secondary outcomes included sleep-related symptoms, quality of life, neurocognitive and mood status as well as office blood pressure measurements. RESULTS From the initial 369 randomized individuals with ≥70 years, 97 (26.3%) with ≥80 years old were included (47 in the CPAP group and 50 in the no-CPAP group). The mean (SD) age was 81.5 (2.4) years. Average use of CPAP was 4.3 (2.6) hours/night (53% with good adherence) Patients in the CPAP group significantly improved snoring and witnessed apneas as well as AHI (from 41.9 to 4.9 events/hour). However no clinical improvements were seen in ESS (-1.2 points, 95%CI, 0.2 to -2.6), any domain of QSQ, any neurocognitive test, OSA-related symptoms, depression/anxiety or blood pressure levels. CONCLUSIONS The present study does not support the use of CPAP in very elderly patients with moderate-to-severe OSA.
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Affiliation(s)
- M A Martinez-Garcia
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - G Oscullo
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Ponce
- Pneumology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - E Pastor
- Pneumology Department, Hospital Universitario San Juan, Alicante, Spain
| | - B Orosa
- Pneumology Department, Hospital Universitario Dr Peset, Valencia, Spain
| | - P Catalán
- Internal Medicine Department, Hospital General de Requena, Valencia, Spain
| | - A Martinez
- Pneumology Department, Hospital General Universitario de Castellón, Spain
| | - L Hernandez
- Pneumology Department, Hospital General Universitario de Alicante, Valencia, Spain
| | - A Muriel
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Nursing Department, Alcala University, Madrid, Spain
| | - E Chiner
- Pneumology Department, Hospital Universitario San Juan, Alicante, Spain
| | - L Vigil
- Pneumology Department, Hospital de Sabadell, Corporació Sanitaria Parc Tauli, Barcelona, Spain
| | - C Carmona
- Pneumology Department, Hospital Universitario Virgen Del Rocio, Sevilla, Spain
| | - M Mayos
- Pneumology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - A Garcia-Ortega
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J D Gomez-Olivas
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - T Beauperthuy
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Bekki
- Pneumology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - D Gozal
- University of Missouri School of Medicine, Department of Child Health, Columbia, MO, USA
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Nagore E, Martinez-Garcia MA, Gomez-Olivas JD, Manrique-Silva E, Martorell A, Bañuls J, Carrera C, Ortiz P, Gardeazabal J, Boada A, de Eusebio E, Chiner E, Gonzalez C, Pérez-Gil A, Cullen D, Formigón M, de Unamuno B, Navarro-Soriano C, Muriel A, Gozal D. Relationship between type 2 diabetes mellitus and markers of cutaneous melanoma aggressiveness: an observational multicentric study in 443 patients with melanoma. Br J Dermatol 2021; 185:756-763. [PMID: 33453061 DOI: 10.1111/bjd.19813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/01/2020] [Accepted: 01/11/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Some studies have suggested a relationship between type 2 diabetes mellitus (T2DM) and increased incidence of melanoma. Efforts are under way to identify preventable and treatable factors associated with greater melanoma aggressiveness, but no studies to date have examined the relationship between T2DM and the aggressiveness of cutaneous melanoma at diagnosis. OBJECTIVES To explore potential associations between T2DM, glycaemic control and metformin treatment and the aggressiveness of cutaneous melanoma. METHODS We conducted a cross-sectional multicentric study in 443 patients diagnosed with cutaneous melanoma. At diagnosis, all patients completed a standardized protocol, and a fasting blood sample was extracted to analyse their glucose levels, glycated haemoglobin concentration and markers of systemic inflammation. Melanoma characteristics and aggressiveness factors [Breslow thickness, ulceration, tumour mitotic rate (TMR), sentinel lymph node (SLN) involvement and tumour stage] were also recorded. RESULTS The mean (SD) age of the patients was 55·98 (15·3) years and 50·6% were male. The median Breslow thickness was 0·85 mm. In total, 48 (10·8%) patients were diagnosed with T2DM and this finding was associated with a Breslow thickness > 2 mm [odds ratio (OR) 2·6, 95% confidence interval (CI) 1·4-4·9; P = 0·004)] and > 4 mm (OR 3·6, 95% CI 1·7-7·9; P = 0·001), TMR > 5 per mm2 (OR 4·5, 95% CI 1·4-13·7; P = 0·009), SLN involvement (OR 2·3, 95% CI 1-5·7; P = 0·038) and tumour stages III-IV (vs. I-II) (OR 3·4, 95% CI 1·6-7·4; P = 0·002), after adjusting for age, sex, obesity, alcohol intake and smoking habits. No significant associations emerged between glycated haemoglobin levels, metformin treatment and melanoma aggressiveness. CONCLUSIONS T2DM, rather than glycaemic control and metformin treatment, is associated with increased cutaneous melanoma aggressiveness at diagnosis.
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Affiliation(s)
- E Nagore
- Dermatology Department, Instituto Valenciano de Oncologia, Valencia, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - M A Martinez-Garcia
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain.,CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - J D Gomez-Olivas
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - E Manrique-Silva
- Dermatology Department, Instituto Valenciano de Oncologia, Valencia, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - A Martorell
- Dermatology Department, Hospital de Manises, Valencia, Spain
| | - J Bañuls
- Dermatology Department, Hospital General de Alicante, Alicante, Spain
| | - C Carrera
- Dermatology Department, Hospital Clinic, Barcelona, Spain
| | - P Ortiz
- Dermatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - J Gardeazabal
- Dermatology Department, Hospital de Cruces, Bilbao, Spain
| | - A Boada
- Dermatology Department, Hospital Germans Trials i Pujol, Barcelona, Spain
| | - E de Eusebio
- Dermatology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - E Chiner
- Pneumology Department, Hospital San Juan de Alicante, Spain
| | - C Gonzalez
- Dermatology Department, Hospital d Getafe, Madrid, Spain
| | - A Pérez-Gil
- Dermatology Department, Hospital de Valme, Seville, Spain
| | - D Cullen
- Dermatology Department, Fundación Jiménez Diaz, Madrid, Spain
| | - M Formigón
- Dermatology Department, Consorcio Sanitario Terrassa, Barcelona, Spain
| | - B de Unamuno
- Dermatology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - C Navarro-Soriano
- Pneumology Department, Hospital Universitario i Politécnico la Fe, Valencia, Spain
| | - A Muriel
- Biostatistic Unit, Hospital Ramón y Cajal. IRYCIS, CIBERESP, Nursery Department and Physiotherapy, Alcalá University, Madrid, Spain
| | - D Gozal
- Department of Child Health, University of Missouri, Columbia, MO, USA
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