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Iannella G, Vicini C, Lechien JR, Ravaglia C, Poletti V, di Cesare S, Amicarelli E, Gardelli L, Grosso C, Patacca A, Magistrelli E, De Benedetto M, Toraldo DM, Arigliani M, Cammaroto G, Meccariello G, De Vito A, Magliulo G, Greco A, de Vincentiis M, Ralli M, Pace A, Montincone V, Maniaci A, Cocuzza S, Seligardi M, di Giacinto I, Corso RM. Association Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep Apnea. Ear Nose Throat J 2024; 103:NP10-NP15. [PMID: 34318690 DOI: 10.1177/01455613211029783] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The purpose of this observational retrospective study was to evaluate, in patients with a severe acute respiratory syndrome coronavirus 2 infection, the association between the severity of coronavirus disease 2019 (COVID-19) respiratory illness and the risk of infected patients to develop obstructive sleep apnea (OSA). METHODS Ninety-six patients with confirmed COVID-19 infection were enrolled in the study. The STOP-BANG questionnaire to investigate the risk of the OSA syndrome was filled in by the patients at admission. The enrolled patients were divided into 2 groups according to the respiratory disease: group 1 (72 patients), hospitalized patients undergoing conventional oxygen therapy; group 2 (24 patients), patients requiring enhanced respiratory support. STOP-BANG results of these 2 groups were compared to observe whether patients with high OSA risk more frequently presented a severe form of COVID-19. RESULTS 41.6% of the patients in group 2 had a STOP-BANG score between 5 and 8 (high risk of having apnea); in contrast, 20.8% of the patients in group 1 had a STOP-BANG score between 5 and 8, with a statistically significant difference between the 2 groups (P = .05). A complementary trend was observed regarding the proportion of patients in the range 0 to 2, which classifies patients at a low risk of OSA (48.6% vs 20.8% for groups 1 and 2, P = .01). CONCLUSIONS According to our data, the chances of having a severe case of COVID-19 should be considered in patients at high risk of OSA. CURRENT KNOWLEDGE/STUDY RATIONALE Emerging research suggests that OSA could represent a potentially important risk factor for the severe forms of COVID-19. The purpose of this observational retrospective study was to evaluate the potential association between OSA and the severity of COVID-19 disease. STUDY IMPACT According to our data, the likelihood of contracting a severe form of COVID-19 disease should be considered in patients at high risk of OSA.
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Affiliation(s)
- Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
- Department of ENT & Audiology, University of Ferrara, Ferrara, Italy
| | - Jerome R Lechien
- Faculty of Medicine, Laboratory of Anatomy and Cell Biology, University of Mons (UMONS), Mons, Belgium
| | - Claudia Ravaglia
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy
| | - Venerino Poletti
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lucia Gardelli
- Medicine Department, G.B. Morgagni Hospital, Forlì, Italy
| | - Carmela Grosso
- Department of Infectious Diseases, G.B. Morgagni Hospital, Forlì, Italy
| | - Aria Patacca
- Department of Infectious Diseases, G.B. Morgagni Hospital, Forlì, Italy
| | | | | | | | | | | | | | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Ospedale "Santa Maria delle Croci", Viale Vincenzo Randi, Ravenna, Italy
| | | | - Antonio Greco
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | | | - Massimo Ralli
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | - Annalisa Pace
- Department of "Organi di Senso," University "Sapienza," Rome, Italy
| | | | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Matteo Seligardi
- Infectious Disease Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio, Emilia, Italy
| | - Ida di Giacinto
- Anesthesia and Intensive Care, Anestesia e Terapia Intensiva Polivalente, Azienda Ospedaliero-Universitaria, Sant'Orsola-Malpighi - Alma Mater Studiorum, Bologna, Italy
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2
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De Corso E, Pipolo C, Cantone E, Ottaviano G, Gallo S, Trimarchi M, Torretta S, Cavaliere C, Lucidi D, Seccia V, Settimi S, Canevari FRM, Pasquini E, La Mantia I, Garzaro M, Bellocchi G, De Benedetto M, Lombardo N, Macchi A, Malvezzi L, Motta G, Vicini C, Maselli A, Dell’Era V, Dragonetti A, Asprea F, Lupato V, Ghidini A, Masieri S, Mattavelli D, Salzano FA, Passali D, Galli J, Pagella F. Practical recommendations for managing severe chronic rhinosinusitis with nasal polyps in the era of biologics. Acta Otorhinolaryngol Ital 2023; 43:324-340. [PMID: 37224173 PMCID: PMC10551726 DOI: 10.14639/0392-100x-n2422] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/09/2023] [Indexed: 05/26/2023]
Abstract
Objective We conducted a national survey to understand how rhinology practice has changed with the advent of biologics and how this affected patients with uncontrolled, severe chronic rhinosinusitis with nasal polyps (CRSwNP). We aimed to analyse the results of the survey and infer practical recommendations for clinical practice. Methods A group of ear, nose, and throat specialists (ENTs) experienced in the management of CRSwNP developed a 74-question survey. ENTs from rhinology centres authorised to prescribe biologics in the context of the national health system were invited to answer it between 01/05/2022 and 31/07/2022. The responses underwent descriptive analyses, and the authors discussed the results and derived practical recommendations for clinical practice. Results ENTs working in rhinology centres changed their practices coinciding with the advent of biologics. CRSwNP evaluations have become more complex because they involve diagnostic confirmation, determining the patients' immunologic profile, and other factors. We observed heterogenous behaviours in practice that may be conditioned by the novelty of the topic. The results of the survey were used to develop practical recommendations for ENTs and are summarised herein. Conclusions Clinical practice in rhinology outpatient clinics has changed profoundly in the era of biologics. Our practical recommendations for clinicians working in rhinology centres are expected to help standardise practice and improve care.
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Affiliation(s)
- Eugenio De Corso
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
| | - Carlotta Pipolo
- Otorhinolaryngology Unit, Head and Neck Department, Dipartimento di Scienze della Salute, Università degli Studi di Milano, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | - Elena Cantone
- Department of Neurosciences, Reproductive and Odontostomatologic Sciences, Unit of Ear, Nose and Throat, “Federico II” University, Naples, Italy
| | - Giancarlo Ottaviano
- Department of Neuroscience DNS, Otolaryngology Section, University of Padua, Padua, Italy
| | - Stefania Gallo
- Otorhinolaryngology Unit, Head and Neck Department, ASST Sette Laghi and UPLOAD Research Center, University of Insubria, Varese, Italy
| | - Matteo Trimarchi
- Division of Head and Neck Department, Otorhinolaryngology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Torretta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Cavaliere
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Daniela Lucidi
- Department of Otolaryngology – Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Veronica Seccia
- Otolaryngology, Audiology, and Phoniatric Operative Unit, Department of Surgical, Medical, Molecular Pathology, and Critical Care Medicine, Pisa University Hospital, Pisa, Italy
| | | | - Frank Rikki Mauritz Canevari
- UOC di Otorinolaringoiatria IRCCS Policlinico San Martino Genova, Dipartimento DISC Università di Genova, Genoa, Italy
| | - Ernesto Pasquini
- ENT Unit “Bellaria” Hospital – Specialized Dep AUSL Bologna, Italy
| | | | | | | | | | - Nicola Lombardo
- ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy
| | - Alberto Macchi
- ENT University of Insubria, ASST Settelaghi, Varese, Italy
| | - Luca Malvezzi
- IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano (MI), Italy
| | - Gaetano Motta
- Otorhinolaryngology – Head and Neck Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Alessandro Maselli
- Department Otorhinolaryngology, Hospital of Barletta, Barletta (BT), Italy
| | - Valeria Dell’Era
- ENT Division, Maggiore Hospital, Eastern Piedmont University – Novara, Italy
| | | | - Francesco Asprea
- Otorinolaringoiatria e audiologia. Università degli studi di Messina, Messina, Italy
| | - Valentina Lupato
- Division of Otolaryngology, Ospedale Civile di Pordenone, Azienda Sanitaria Friuli Occidentale (ASFO), Pordenone, Italy
| | - Angelo Ghidini
- Otorinolaringoiatria Azienda USL di Reggio Emilia/IRCCS, Italy
| | - Simonetta Masieri
- Dipartimento di scienze odontostomatologiche e maxillo facciali. Sapienza University of Rome, Rome, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia – University of Brescia, Brescia, Italy
| | | | | | - Jacopo Galli
- Otorhinolaryngology Unit, Head and Neck Department, A. Gemelli Universitary Hospital Foundation IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Fabio Pagella
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
- Otorhinolaryngology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Toraldo DM, Arigliani M, De Benedetto M. Depressed ventilatory drive for respiratory muscle weakness and chemo-responsiveness as a pathophysiological mechanism of CSA after surgery for obstructive sleep apnoea. ACTA ACUST UNITED AC 2021; 40:311-312. [PMID: 33100342 PMCID: PMC7586187 DOI: 10.14639/0392-100x-n0443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Domenico Maurizio Toraldo
- Department of Rehabilitation "V. Fazzi" Hospital, Cardio-Respiratory Unit Care, ASL/Lecce, San Cesario di Lecce, Lecce, Italy
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De Corso E, Bellocchi G, De Benedetto M, Lombardo N, Macchi A, Malvezzi L, Motta G, Pagella F, Vicini C, Passali D. Biologics for severe uncontrolled chronic rhinosinusitis with nasal polyps: a change management approach. Consensus of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in rhinology. ACTA ACUST UNITED AC 2021; 42:1-16. [PMID: 34297014 PMCID: PMC9058929 DOI: 10.14639/0392-100x-n1614] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/16/2021] [Indexed: 02/07/2023]
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous inflammatory condition of nasal mucosa and paranasal sinuses, predominantly mediated by type 2 inflammation and often associated with comorbid asthma and/or Exacerbated Respiratory Disease (N-ERD). The standard of care involves local and systemic corticosteroids and/or sinonasal surgery, although these options may be associated with recurrences and patients may require revision surgery. Difficult-to-treat patients, in fact, have a more severe disease requiring high systemic corticosteroid use and/or multiple sinonasal surgeries. Literature data suggests that biologic agents targeting specific key effectors of type 2 inflammation may offer supplemental therapy for patients with severe and uncontrolled CRSwNP, leading to significant improvement in several outcomes. For these reasons, over the years the endotyping of the disease has become increasingly important. Herein, we provide not only an update on the existing studies about the most promising biologics in CRSwNP, but also critical discussion on controversies about the use of biologics in severe uncontrolled CRSwNP. We finally provide consensus on strategic issues gathered among experts of the Joint Committee of Italian Society of Otorhinolaryngology on biologics in order to offer the best care for difficult to treat patients.
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Affiliation(s)
- Eugenio De Corso
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Head and Neck Surgery - Otorhinolaryngology, Rome, Italy
| | | | | | - Nicola Lombardo
- ENT Unit Department of Medical and Surgical Sciences, University Magna Græcia Catanzaro, Italy
| | - Alberto Macchi
- ENT University of Insubria, Varese, ASST Settelaghi, Italy
| | - Luca Malvezzi
- IRCCS Humanitas Research Hospital, Department of Otorhinolaryngology and Head and Neck Surgery, Rozzano, Milan, Italy
| | - Gaetano Motta
- Otorhinolaryngology-Head and Neck Surgery, University of Campania L. Vanvitelli, Napoli, Italy
| | - Fabio Pagella
- ENT Department, I.R.C.C.S. Policlinico San Matteo- University of Pavia, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
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Macchitella L, Romano DL, Marinelli CV, Toraldo DM, Arigliani M, De Benedetto M, Angelelli P. Neuropsychological and socio-cognitive deficits in patients with obstructive sleep apnea. J Clin Exp Neuropsychol 2021; 43:514-533. [PMID: 34212782 DOI: 10.1080/13803395.2021.1944609] [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] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive deficits. We investigated the cognitive and socio-cognitive profiles of patients with severe OSA, controlling for potentially relevant mediating variables (i.e. age, body-mass index, cognitive reserve and depression). Moreover, we studied the neuropsychological profile of a high-risk OSA phenotype characterized by severe OSA and severe nocturnal hypoxemia.Method: We assessed 29 previously untreated severe OSA patients with a mean age of 55.6 (± 9.9 years) and a mean apnea-hypopnea index (AHI) of 53.1 (± 17.4). A control group of 34 healthy participants was also enrolled. Participants completed an extensive neuropsychological battery that included social cognition, a relatively new investigation area among OSA patients.Data analysis: Data were analyzed with a Bayesian approach. Specifically, Bayesian ANCOVA was used to investigate whether the grouping variable could predict test performance. Age, body-mass index, cognitive reserve and state of depression were added as covariates to the null model to weight the effects of these potential confounding factors. Three groups were analyzed: healthy controls (H), OSA with severe apnea and severe nocturnal oxygen desaturation (D+), and OSA with severe apnea non-desaturators (D-). Performances on the various neuropsychological tests were treated as the dependent variables.Results: The results indicate that non-verbal reasoning, the theory of mind skills, and mental shifting ability were impaired in OSA patients. Patients with severe nocturnal hypoxemia underperformed compared to patients with the same severity of apnea but non-desaturators. Additionally, we observed a trend toward a worse performance among OSA desaturator patients in the following abilities: constructional ability, short term verbal memory, phonological fluency, and the ability to inhibit automatic and dominant responses.Conclusion: The data suggest a key role of hypoxemia in affecting cognitive functioning in OSA patients. Executive functions and the concomitant involvement of social cognition are particularly affected.
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Affiliation(s)
- Luigi Macchitella
- Department of History, Society and Human Studies - Lab of Applied Psychology and Intervention, University of Salento, Lecce, Italy
| | - Daniele Luigi Romano
- Department of History, Society and Human Studies - Lab of Applied Psychology and Intervention, University of Salento, Lecce, Italy.,Department of Psychology and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Milan, Italy
| | - Chiara Valeria Marinelli
- Department of History, Society and Human Studies - Lab of Applied Psychology and Intervention, University of Salento, Lecce, Italy.,Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Michele Arigliani
- Department of ENT (Otolaryngology), "V. Fazzi" Hospital, Lecce, Italy
| | | | - Paola Angelelli
- Department of History, Society and Human Studies - Lab of Applied Psychology and Intervention, University of Salento, Lecce, Italy
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Conte L, Greco M, Toraldo DM, Arigliani M, Maffia M, De Benedetto M. A review of the "OMICS" for management of patients with obstructive sleep apnoea. ACTA ACUST UNITED AC 2021; 40:164-172. [PMID: 32773777 PMCID: PMC7416376 DOI: 10.14639/0392-100x-n0409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022]
Abstract
Obstructive sleep apnaea (OSA) syndrome is a condition characterised by the presence of complete or partial collapse of the upper airways during sleep, resulting in fragmentation of sleep associated with rapid episodes of intermittent hypoxia (IH), activation of the sympathetic nervous system and oxidative stress. OSA is associated with a broad spectrum of cardiovascular, metabolic and neurocognitive comorbidities that appear to be particularly evident in obese patients, while affecting both sexes in a different manner and varying in severity according to gender and age. In recent years, studies on OSA have increased considerably, but in clinical practice, it is still a highly underdiagnosed disease. To date, the gold standard for the diagnosis of OSA is nocturnal polysomnography (PSG). However, since it is not well suited for a large number of patients, the Home Sleep Test (HST) is also an accepted diagnostic method. Currently, the major aim of research is to identify non-invasive methods to achieve a highly predictive, non-invasive screening system for these subjects. The most recent reports indicate that research in this field has made significant progress in identifying possible biomarkers in OSA, using -OMIC approaches, particularly in the fields of proteomics and metabolomics. In this review, we analyse these OMIC biomarkers found in the literature.
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Affiliation(s)
- Luana Conte
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, Lecce, Italy.,Laboratory of Advanced Data Analysis for Medicine (ADAM), Department of Mathematics and Physics "E. De Giorgi", University of Salento, Lecce, Italy
| | - Marco Greco
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, Lecce, Italy.,Laboratory of Physiology, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Domenico Maurizio Toraldo
- Department Rehabilitation "V. Fazzi" Hospital, Cardio-Respiratory Unit Care, ASL-Lecce, San Cesario di Lecce (LE), Italy
| | | | - Michele Maffia
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, Lecce, Italy.,Laboratory of Physiology, Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy.,Laboratory of Clinical Proteomic, "Giovanni Paolo II" Hospital, ASL-Lecce, Italy
| | - Michele De Benedetto
- Interdisciplinary Laboratory of Applied Research in Medicine (DReAM), University of Salento, Lecce, Italy
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Angelelli P, Macchitella L, Toraldo DM, Abbate E, Marinelli CV, Arigliani M, De Benedetto M. The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment. Brain Sci 2020; 10:brainsci10060325. [PMID: 32471112 PMCID: PMC7349097 DOI: 10.3390/brainsci10060325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive disturbances. One of the neuropsychological processes most investigated in OSA patients is attention, but the results have been controversial. Here, we update the attention profile of OSA patients with the final aim to improve attention assessment, with a possible impact on clinical and medical-legal practices, in terms of which attention subdomains and parameters need consideration and which one is a high-risk OSA phenotype for attention dysfunctions. Method: For this purpose, we assessed 32 previously untreated OSA patients (26 men and 6 women) under 65 years of age (mean age 53.2 ± 7.3; mean education level 10.4 ± 3.4 years) suffering from moderate to severe sleep apnea and hypopnea (mean apnea-hypopnea index (AHI) 45.3 ± 22.9, range 16.1–69.6). A control group of 34 healthy participants matched with OSA patients for age, education level, and general cognitive functioning were also enrolled. The OSA patients and healthy participants were tested through an extensive computerized battery (Test of Attentional Performance, TAP) that evaluated intensive (i.e., alertness and vigilance) and selective (i.e., divided and selective) dimensions of attention and returned different outcome parameters (i.e., reaction time, stability of performance, and various types of errors). Data analysis: The data were analyzed by ANCOVA which compared the speed and accuracy performance of the OSA and control participants (cognitive reserve was treated as a covariate). The possible mechanisms underlying attention deficits in OSA patients were examined through correlation analysis among AHI, oxygenation parameters, sleepiness scores, and TAP outcomes and by comparing the following three phenotypes of patients: severe OSA and severe nocturnal desaturators (AHI++D+), severe OSA nondesaturators (AHI++D−), and moderate OSA nondesaturators (AHI+D−). Results: The results suggest that the OSA patients manifest deficits in both intensive and selective attention processes and that reaction time (RT) alone is ineffective for detecting and characterizing their problems, for which error analysis and stability of performance also have to be considered. Patients with severe OSA and severe hypoxemia underperformed on alertness and vigilance attention subtests. Conclusions: The data suggest the importance of evaluating attention deficits among OSA patients through several parameters (including performance instability). Moreover, the data suggest a multifaceted mechanism underlying attention dysfunction in OSA patients.
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Affiliation(s)
- Paola Angelelli
- Lab of Applied Psychology and Intervention, Department of History, Society and Human Studies, University of Salento, 73100 Lecce, Italy; (L.M.); (E.A.); (C.V.M.)
- Correspondence:
| | - Luigi Macchitella
- Lab of Applied Psychology and Intervention, Department of History, Society and Human Studies, University of Salento, 73100 Lecce, Italy; (L.M.); (E.A.); (C.V.M.)
| | | | - Elena Abbate
- Lab of Applied Psychology and Intervention, Department of History, Society and Human Studies, University of Salento, 73100 Lecce, Italy; (L.M.); (E.A.); (C.V.M.)
| | - Chiara Valeria Marinelli
- Lab of Applied Psychology and Intervention, Department of History, Society and Human Studies, University of Salento, 73100 Lecce, Italy; (L.M.); (E.A.); (C.V.M.)
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Toraldo DM, Benedetto MD, Conte L, De Nuccio F. Statins May Prevent Atherosclerotic Disease in OSA Patients without Co-Morbidities? Curr Vasc Pharmacol 2017; 15:5-9. [PMID: 27748200 DOI: 10.2174/1570161114666161007164112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/13/2016] [Accepted: 10/04/2016] [Indexed: 11/22/2022]
Abstract
Obstructive sleep apnoea (OSA) is characterized by repetitive interruptions of breathing, causing Chronic Intermittent Hypoxia (CIH) that can be involved in the development and progression of cardiovascular diseases. There is evidence showing a close relationship between OSA and atherosclerosis, even in patients who do not show co-morbidities such as hypertension, diabetes, high levels of lowdensity lipoprotein cholesterol (LDL-C), cigarette smoking and obesity, which can activate the endothelium. This endothelium activation due to CIH and specific to OSA seems to be dependent on a different pathway. The current first line therapy for OSA is the application of the continuous positive airway pressure (CPAP), but it alone is not enough to reduce cardiometabolic risk in patients with OSA. In contrast, statins, via their pleiotropic property, might be able to change inflammation and early atherosclerosis, lipid profile and cardiovascular outcomes in OSA. The role of statins in OSA patients with or without any co-morbidities could potentially prevent coronary vascular risk and stroke and in the future, represent an additional treatment option along with CPAP therapy. Strengthening the prevention strategies against atherosclerosis in OSA should be one of the focal aims for healthcare programs of the future.
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Affiliation(s)
| | | | | | - Francesco De Nuccio
- Laboratory of Human Anatomy and Neuroscience, Department of Biological and Environmental Sciences and Technologies, University of Salento, str. Prov.le Lecce- Moneteroni, Ecotekne Center, 73100 Lecce, Italy.
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De Benedetto M, Garbarino S, Sanna A. Obstructive sleep apnea (OSA): healthcare and social costs. Med Lav 2017; 108:310-313. [PMID: 28853431 DOI: 10.23749/mdl.v108i4.6411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/14/2017] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) syndrome is an underdiagnosed widespread chronic disease involving both sexes and all ages. Undiagnosed and untreated OSA is associated with workplace productivity losses and significant direct and indirect medical costs. A cost analysis of OSA was carried out in Italy ten years ago. Overall OSA medical costs, largely due to treatment of comorbidity, amounted to € 2,9 billion or 55% of total medical costs. Direct medical costs, due to diagnosis and treatment of OSA, were 6% of overall OSA costs, while medical costs due to the absence of diagnosis and of prevention of comorbidities represented 49% of the overall cost. Non-medical costs made up for the remaining 45%. € 1.5 billion could be saved by promoting screening campaigns aimed at detecting OSA that would otherwise remain undiagnosed and by improving adherence to treatment. Bearing in mind the increasing OSA prevalence and the recent quantification of avoidable OSA-related road accidents, the real cost of OSA is higher than estimated up to now.
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Costa G, De Benedetto M. Obstructive Sleep Apnea Syndrome (OSAS): Occupational Health and other medical disciplines facing the problem. Med Lav 2017; 108:247-250. [PMID: 28853421 DOI: 10.23749/mdl.v108i4.6423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/21/2017] [Indexed: 11/17/2022]
Abstract
Obstructive Sleep Apnea Syndrome (OSAS) is one of the most common causes of excessive daytime sleepiness, therefore an important determinant of road and work accidents, as well as being associated with multiple chronic-degenerative diseases. The recent transposition of the European Commission Directive 2014/85/EU on driver licensing highlighted the need to tackle the problem appropriately, not only for its high prevalence in the general population, but also for its significant impact on occupational safety and health, and related social costs. The Occupational Health Physician is required to play a strategic role in this regard, not just for early diagnosis, but also for monitoring the therapeutic efficacy in maintaining or reintegrating workers into specific jobs. The effectiveness of his/her work will depend primarily on the level of interaction he/she will be able to establish with the different specialists who are in charge of the diagnostic and therapeutic process, in order to maintain a satisfactory work performance and to prevent possible deleterious effects on health in the medium and long-term period. The logic of this multidisciplinary approach has led nineteen scientific Societies and Associations to establish a Joint Technical Committee and to address the problem in the light of effectiveness and efficiency criteria in the interest of the individual and the community.
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Sanna A, Passali D, De Benedetto M, Marano G, Loglisci M, Garbarino S. Obstructive sleep apnea syndrome and public health: the Italian way. Sleep Breath 2017; 21:995-996. [PMID: 28405883 DOI: 10.1007/s11325-017-1487-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 02/11/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Antonio Sanna
- Azienda USL Toscana Centro, Pneumology Unit, San Jacopo Hospital, Pistoia, Italy
| | | | - Michele De Benedetto
- Department of Otolaryngology Head and Neck Surgery, Hospital Fazzi, Lecce, Italy
| | - Giancarlo Marano
- Directorate-Generale for health prevention-Ministry of Health, Rome, Italy
| | - Michele Loglisci
- ENT Department, University of Siena, Viale Bracci 16, Siena, Italy
| | - Sergio Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,State Police Health Service Department, Ministry of the Interior, Rome, Italy
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Toraldo DM, De Benedetto M, Scoditti E, De Nuccio F. Obstructive sleep apnea syndrome: coagulation anomalies and treatment with continuous positive airway pressure. Sleep Breath 2015; 20:457-65. [PMID: 26169715 DOI: 10.1007/s11325-015-1227-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/22/2015] [Accepted: 06/29/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder associated with severe cardiovascular events, morbidity and mortality. Recent evidence has highlighted OSAS as an independent risk factor for an excessive platelet activation and arterial thrombosis, but the underlying mechanisms have not yet been determined. Studies in cell culture and animal models have significantly increased our understanding of the mechanisms of inflammation in OSAS. Hypoxia is a critical pathophysiological element that leads to an intense sympathetic activity, in association with systemic inflammation, oxidative stress and procoagulant activity. While platelet dysfunction and/or hypercoagulability play an important role in the pathogenesis of vascular disease, there are limited studies on the potential role of blood viscosity in the development of vascular disease in OSAS. CONCLUSION Further studies are required to determine the precise role of hypercoagulability in the cardiovascular pathogenesis of OSAS, particularly its interaction with oxidative stress, thrombotic tendency and endothelial dysfunction. Nasal continuous positive airway pressure (nCPAP), the gold standard treatment for OSAS, not only significantly reduced apnea-hypopnoea indices but also markers of hypercoagulability, thus representing a potential mechanisms by which CPAP reduces the rate of cardiovascular morbidity and mortality in OSAS patients.
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Affiliation(s)
| | | | - Egeria Scoditti
- National Research Council (CNR), Institute of Clinical Physiology, Lecce, Italy
| | - Francesco De Nuccio
- Laboratory of Human Anatomy and Neuroscience, Department of Biological and Environmental Sciences and Technologies, University of Salento, Via Prov. le Lecce-Monteroni (Centro Ecotekne), 73100, Lecce, Italy.
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De Benedetto M, Passali D, Tomacelli G, Ruggieri A, Rosignoli MT, Picollo R, Bellussi L, Dionisio P. Penetration of prulifloxacin into sinus mucosa of patients undergoing paranasal sinus elective endoscopic surgery. J Chemother 2012; 24:26-31. [PMID: 22546721 DOI: 10.1179/1120009x12z.0000000009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this study was to assess the concentration of ulifloxacin, the active metabolite of prulifloxacin, in sinuses mucosa and plasma of patients with chronic rhinosinusitis, requiring sinus elective endoscopic surgery. Thirty-nine patients (30 males, 9 females; age range 22-77 years) with chronic sinusitis were enrolled, 35 were treated with the investigational medication. Samples from four untreated patients were used to validate the analytical method, while four treated patients dropped out before surgery. One 600 mg prulifloxacin tablet once daily was administered for 5 days before surgery. The last dosing was scheduled from 2 to 12 hours from tissue and plasma sampling. In each patient, two samples of paranasal sinus mucosa (from ethmoid and turbinate, respectively) and one blood sample were collected. Concentrations of ulifloxacin in plasma and sinuses mucosa were measured using validated bioanalytical LC/MS/MS methods. Individual and mean ulifloxacin concentrations in tissues were always higher than the relevant plasma levels. The highest concentrations were observed between 2.5 and 4.5 hours after the last dosing in all districts. The mean tissue/plasma ratios were 2.5 and 3.0 for ethmoid and turbinate, respectively. Data expressed as Area Under the Curves (AUC±SD) showed that ulifloxacin concentrations in the ethmoid were slightly higher (18.68±6.48 μg/g*h) than in turbinate (15.00±2.89 μg/g*h), and definitely higher than in plasma (6.32±1.14 μg/ml*h). The AUC ratios between tissues and plasma were 3.0 for ethmoides and 2.4 for turbinates. One patient reported two treatment-related episodes of diarrhea, which spontaneously resolved after the drug suspension. Results from this study seem to suggest that prulifloxacin showed good distribution in sinus tissues, where it reaches concentrations significantly higher than in plasma. These findings strongly call for confirmatory clinical trials in patients with bacterial rhinosinusitis.
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Toraldo DM, Peverini F, De Benedetto M, De Nuccio F. Obstructive sleep apnea syndrome: blood viscosity, blood coagulation abnormalities, and early atherosclerosis. Lung 2012; 191:1-7. [PMID: 23076780 DOI: 10.1007/s00408-012-9427-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 09/25/2012] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for atherosclerosis and arterial thrombosis, which are associated with high cardiovascular (CV) morbidity and mortality. In studies performed in clinical populations with elevated CV event risk profiles, the occurrence of moderate to severe OSAS was very often accompanied by a worsened vascular function and increased prevalence of structural abnormalities. Recent investigations of atherosclerosis in OSAS have focused on thrombotic tendency and blood viscosity, providing new insight into mechanisms of the disease. Despite that knowledge about the mechanisms of development of CV disease in patients with OSAS is still incomplete, observations confirm a relationship between sleep-disordered breathing and the rheological properties (flow properties) of blood. While platelet dysfunction and hypercoagulability (PDMPs, PaI-1, and SF) play important roles in the pathogenesis of vascular disease, there are limited studies on the potential role of blood viscosity in the development of vascular disease in OSAS.
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Affiliation(s)
- Domenico Maurizio Toraldo
- Third Division, A. Galateo Lung Disease Hospital, ASL Lecce, via a.c Casetti n. 2, 73100, Lecce, Italy.
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Bellussi L, De Benedetto M, Giordano C, Mira E, Paludetti G, Passáli D, Scaglione F. [Crenotherapy and upper airways diseases. Consensus Conference]. Acta Otorhinolaryngol Ital 2006; 26:5-54. [PMID: 17465395] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Grandis S, Aimone M, Cavallo F, De Benedetto M, Succo G. [Relationship between health economics and bioethics in otorhinolaryngology. Round table discussion at 26th National Congress of Italian Otorhinolaryngology, Udine, September 20-21, 2002]. Acta Otorhinolaryngol Ital 2003; 23:203-14. [PMID: 14677316] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Abstract
This paper presents pragmatic particulars pertaining to plume protection problems with special emphasis on the health care environment. Practical approaches to optimizing protection are discussed with an eye toward facilitating the safety of personnel and the general health care environment from particulates, parasites, viruses and other undesirable entities, elements and compounds.
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Affiliation(s)
- J M Kokosa
- GMI Engineering & Management Institute, Flint, MI 48504
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Benedetto MD. Exploring use of laser to determine caries location. J Laser Appl 1990; 2:83. [PMID: 10149085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Benedetto MD, Antonson DE. Use of CO2 laser for visible detection of enamel fissure caries. Quintessence Int 1988; 19:187-90. [PMID: 3152014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Antonson DE, Benedetto MD. Longitudinal intensity variability of visible light curing units. Quintessence Int 1986; 17:819-20. [PMID: 3468533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Antonson DE, Benedetto MD. Ophthalmic concerns when using visible light curing units. Quintessence Int 1986; 17:679-82. [PMID: 3466198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Patients with optic neuritis describe image fading which is particularly evident at bright light levels. The effect is dependent on adaptation level, and high adaptation levels serve as a provocative test. Kinetic and static perimetry and interferometric acuity tests repeated in time reveal this loss in sensitivity. The latter test, using a large field and a high luminance level, is particularly sensitive to both the residua of pathology and very early phases of disease, often before subjective manifestations of anomalies are present. These effects are large in patients with demyelinating diseases. Here, we show that such changes may be revealed in optic neuritis due to other causes as well. Note, the same form of response may be detected in more central lesions, but usually in more circumscribed areas of field.
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Fitzgerald CR, Enoch JM, Birch DG, Benedetto MD, Temme LA, Dawson WW. Anomalous pigment epithelial photoreceptor relationships and receptor orientation. Invest Ophthalmol Vis Sci 1980; 19:956-66. [PMID: 7409989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In order to further investigate the factors influencing retinal receptor orientation, three patients with local disturbances of the receptor/pigment epithelium (PE) interface have been evaluated. Psychophysical and clinical tests have been used to characterize the observed abnormalities. The following conclusions are made. Receptor orientation is lost following a serous detachment of the neurosensory retina and can recover following reattachment of the retina. Orientation may be retained despite the presence of serous detachment of the PE, loss of the light/dark component of the electro-oculogram, and vitelliform-like lesions between the receptors and the PE.
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Abstract
Development of a syrinx several years post spinal cord trauma is a well-known entity and described in a number of scientific communications. Each one describes the few cases encountered with the clinical presentations; many report results of myelography with positive or negative contrast media, operative procedures, and eventual outcome as well as discussions of autopsy material. It is believed by many investigators and clinicians that surgical intervention frequently stops the progression of the syrinx and sometimes even reverses the symptomatology. Early exact diagnosis is thus paramount. Electromyography if used judiciously, may be an important adjunct to proper diagnosis and prognosis. In a patient with previous spinal cord trauma, frequently even post-surgical procedures, the interpretation is often difficult. This paper discusses the electrodiagnostic findings in three patients with post-traumatic syrinx and compares them with electrodiagnostic changes observed in a spinal cord injury patient with increased symptomatology due to other causes and two patients with non-traumatic cervical syringomyelia.
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