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The treatment for obstructive sleep apnoea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is associated with blood pressure (BP) reduction; however, the overall effect is modest. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MADs with either passive or active treatment. When all the studies were pooled together, CPAP and MADs were associated with a mean BP reduction of −2.09 (95% CI −2.78– −1.40) mmHg for systolic BP and −1.92 (95% CI −2.40– −1.43) mmHg for diastolic BP and −1.27 (95% CI −2.34– −0.20) mmHg for systolic BP and −1.11 (95% CI −1.82– −0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those aged Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of BP control. These findings should be interpreted with caution; however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.

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

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

Background and purpose: Both obstructive sleep apnea (OSA) and cardiac organ damage have a crucial role in acute ischemic stroke. Our aim is to explore the relationship between OSA and cardiac organ damage in acute stroke patients. Methods: A total of 130 consecutive patients with acute ischemic stroke were enrolled. Patients underwent full multichannel 24-h polysomnography for evaluation of OSA and echocardiography to evaluate left ventricle (LV) mass index (LV mass/BSA, LV mass/height 2.7), thickness of interventricular septum (IVS) and posterior wall (LVPW), LV ejection fraction and left atrium enlargement. Information on occurrence of arterial hypertension and its treatment before stroke was obtained from patients' history. Results: 61.9% (70) of patients, mostly men (67.1%), with acute stroke had OSA (AHI > 10). Patients with acute stroke and OSA showed a significant increase (P < 0.05) of LV mass index, IVS and LVPW thickness and a significant left atrial enlargement as compared with patients without OSA. LV ejection fraction was not significantly different in stroke patients with and without OSA and was within normal limits. No relationship was found among cardiac alterations, occurrence of OSA and history of hypertension. Conclusion: Acute stroke patients with OSA had higher LV mass and showed greater left atrial enlargement than patients without OSA. This study confirms the high prevalence of OSA in stroke patients, suggesting also an association between OSA and cardiac target organ damage. Our finding of structural LV abnormalities in acute stroke patients with OSA suggests a potential role of OSA as contributing factor in determining both cerebrovascular and cardiac damage, even in absence of clear link with a history of blood pressure elevation.

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

Objective To assess sleep characteristics and the occurrence of abnormal muscle activity during sleep, such as REM sleep without atonia (RSWA), REM sleep behavior disorder (RBD), and periodic leg movements during sleep (PLMS), in patients with amyotrophic lateral sclerosis (ALS). Methods A total of 41 patients with ALS and 26 healthy subjects were submitted to clinical interview and overnight video-polysomnography. Results A total of 22 patients with ALS (53.6%) reported poor sleep quality. Polysomnographic studies showed that patients with ALS had reduced total sleep time, increased wakefulness after sleep onset, shortened REM and slow-wave sleep, and decreased sleep efficiency, compared to controls. Polysomnographic abnormalities were not different in patients reporting good or poor sleep and were not correlated to clinical and demographic variables. The PLMS index was significantly higher in patients with ALS than in healthy subjects, and 22 patients (53.6%) showed a PLMS index > 15/h, vs 4 (15.4%) controls (P < 0.001). Finally, two patients with ALS (4.9%) had RBD, and two more patients presented RSWA (4.9%), whereas no controls showed abnormalities of REM sleep. Conclusion Patients with ALS frequently present abnormalities of sleep that can be documented both at the clinical interview and at the polysomnographic evaluation, including insomnia, fragmented sleep, and increased PLMS. Moreover, abnormalities of REM sleep can be found in some of these patients.

Background Repetitive transcranial magnetic stimulation (rTMS) over right posterior parietal cortex was shown to induce interference on visuospatial perception in healthy subjects. Transcranial direct current stimulation (tDCS) is another noninvasive brain stimulation technique that works modulating cortical activity. It is applied through easy to use, noncostly, and portable devices. Objective/Hypothesis The aim of the current study was to investigate if the novel approach of “dual” stimulation over parietal cortices compared with the unilateral (right) cathodal one is able to induce greater and/or longer-lasting neglect-like effects in normal subjects performing a computerized visuospatial task. Methods Eleven healthy subjects underwent a computerized visuospatial task requiring judgments about the symmetry of prebisected lines in baseline condition, during and after tDCS. Right cathodal and left anodal tDCS were simultaneously applied over homologue posterior parietal cortices in the “dual” approach, whereas right cathodal tDCS was used in the traditional unihemisphere stimulation. Results A significant rightward bias in symmetry judgments as compared with baseline and sham conditions was observed in both the stimulation approaches. With “dual” tDCS compared with cathodal stimulation the effect was stronger and appeared earlier, but no longer-lasting after effects were found. Conclusions We speculate that the resulting modulation of interhemispheric inhibition mediated the additional rightward bias in task performance for “dual” hemisphere compared with unihemisphere tDCS. If “dual” tDCS may better reproduce mechanisms underlying real lesions, it could provide a more suitable model for rehabilitation of negligent patients.

Objective To evaluate the frequency, severity and determinants of sleep disturbances in patients with amyotrophic lateral sclerosis (ALS). Methods Information about night-time complaints was collected using a standardised questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS) in a group of 100 patients with ALS and in 100 control subjects matched for age and sex. Functional disability was assessed using the ALS Functional Rating Scale-Revised (ALSFRS-R). Sleep was studied by overnight polysomnography in 12 patients. Results Fifty-nine patients with ALS and 36 controls reported sleep disturbances. The mean global PSQI score of patients with ALS was significantly higher than the control participants (6.82±4.0 vs 4.86±3.2), and three of the seven components of PSQI in patients with ALS were significantly different from controls: ‘sleep latency,’ ‘habitual sleep efficiency’ and ‘sleep disturbances.’ The most commonly reported night-time complaints by patients with ALS were nocturia (54%), sleep fragmentation (48%) and nocturnal cramps (45%). Poor sleep was associated with decreased ALSFRS-R score, highest depression and ESS score. After a multivariate analysis, patients9 disability and daytime somnolence remained significantly associated with sleep quality. Polysomnographic studies showed decreased sleep efficiency and fragmented sleep architecture. Conclusion This study demonstrated that patients with ALS have a significant poor quality of sleep, and this correlated with the severity of ALS and daytime somnolence. Increased awareness for sleep–wake problems in patients with ALS is important, as effective intervention could lead to a better management of these patients.

Objective:To explore the effects of BB on nocturnal peri-apnoeic heart rate variability (HRV) and on arrhythmias in OSA patients.Design and method:Arrhythmias and increased cardiovascular V are highly prevalent in patients with obstructive sleep apneas (OSA), possibly resulting in fatal events, as s

E vidence is available that the frequency and severity of arterial hypertension, and, in general, of cardiovascular diseases, bear a relationship with sleep disorders and, more specifically, with sleep duration [1,2]. Indeed, on the one side patients with cardiovascular diseases often complain of a number of sleep disturbances, including sleep fragmentation, insomnia, and breathing disorders during sleep. On the other side, patients with sleep complaints seem to be more frequently affected by cardiovascular problems. Given such a complex bidirectional relationship between these phenomena, it is therefore often difficult to determine which is the cause and which is the effect between cardiovascular problems and sleep disorders. Sleep-related breathing disorders, and, in particular, obstructive sleep apnea (OSA) syndrome, formerly named Pickwickian syndrome [3], are among the most common problems occurring during sleep in the general population, with at least 4% of middle-aged men and 2% of middle-aged women being affected in the developed world, its prevalence is increasing in parallel with the increasing prevalence of obesity [4–6]. A number of studies have shown OSA to be strictly related to the presence of hypertension and to represent an independent risk factor for the development of a high blood pressure (BP) condition [5,6]. Evidence of a relationship between arterial hypertension and excessive daytime somnolence has also been provided [7,8], whereas sleep fragmentation and a reduction in nocturnal sleep duration have been identified as factors majorly responsible for the increased sympathetic activity and the occurrence of elevated BP levels extending during daytime [9,10]. Given the large number of papers demonstrating the complex and multiple links relating sleep disorders and sleep duration with the occurrence of high BP levels, it is somehow surprising that only limited evidence has been up

BACKGROUND: The association of obstructive sleep apnea (OSA) with glucose intolerance and the beneficial effect of lifestyle intervention have been poorly investigated in women particularly before menopausal status. The study explored 1) whether OSA is associated with impaired glucose homeostasis in obese non diabetic premenopausal and menopausal women and 2) the effects of a 3- month lifestyle intervention on glucose homeostasis in OSA women. DESIGN AND METHODS: We consecutively recruited 98 obese women (39 premenopausal) from those referred for a weight loss intervention. Ambulatory nocturnal polysomnography, body composition, oral glucose tolerance test, insulin sensitivity and β cell function were assessed before and after intervention. RESULTS: 41% of premenopausal and 64% of menopausal women had OSA which was associated with worse glucose homeostasis before menopausal status. Mean and minimal nocturnal oxygen saturation (SaO2) was associated with neck/height ratio (NHR), independently of total and central obesity. Mean and minimal nocturnal SaO2 and NHR were correlated with insulin sensitivity and fasting glucose. In multivariate analyses, nocturnal mean SaO2 was negatively and independently correlated with fasting glucose (p

Introduction In the last few years, it has been increasingly recognized that patients with amyotrophic lateral sclerosis (ALS) frequently suffer of sleep-related complaints, including insomnia, restless legs syndrome, and daytime sleepiness, although, in the past, many of the nocturnal symptoms have been mainly ascribed to chronic respiratory insufficiency and hypoventilation. In addition, excluding few single cases reported, polysomnographic studies did not look for abnormal motor activity during sleep that could be indicative of Rapid Eye Movements (REM) sleep behavior disorder (RBD) and REM sleep without atonia (RSWA), which are highly prevalent in other neurodegenerative disorders with brainstem involvement. Finally, data on the presence of periodic leg movements in sleep (PLMS) in patients with ALS are sparse. We sought to assess sleep characteristics and the occurrence of abnormal muscle activity during sleep, such as RSWA, RBD, and PLMS in patients with ALS. Materials and methods Forty-one patients with ALS and 26 healthy subjects were submitted to clinical interview and overnight video-polysomnography. Results Twenty-two patients with ALS (53.6%) reported poor sleep quality. Polysomnographic studies showed that patients with ALS had reduced total time of sleep, increased wakefulness after sleep onset, shortened REM and slow wave sleep, and decreased sleep efficiency compared to control subjects. Polysomnographic abnormalities were not different in patients reporting good or poor sleep, and were not correlated to clinical and demographic variables. PLMS index was significantly higher in patients with ALS than in healthy subjects, and 22 patients (53.6%) showed a PLMS index > 15, vs 4 (15.4%) control subjects (p 0.001). Finally, two patients with ALS (4.9%) had RBD, and two more patients presented RSWA (4.9%), whereas no control subjects showed abnormalities of REM sleep. Conclusion Patients with ALS frequently present abnormalities of sleep that can be documented both at the clinical interview and at the polysomnographic evaluation, including insomnia, fragmented sleep, and increased PLMS. Moreover, abnormalities of REM sleep can sometimes be found in these patients. Acknowledgements The authors would like to thank Dr. A. Mattaliano, Ospedale Civico ARNAS of Palermo, Dr. V. La Bella, University of Palermo-Italy, and Dr. G. Borghero, University of Cagliari-Italy, for their important contribution.

Purpose: Periodic breathing (PB) is frequently reported at night at high altitude. We have previously shown that this respiratory pattern is less frequent in female subjects. Little is known about gender differences on the acetazolamide effect on this phenomenon. Aim of our randomized, double blind study was to explore whether acetazolamide may influence PB during sleep in males and females subjects under acute exposure to high altitude hypoxia. Methods: All subjects (43 healthy subjects, 22 male) participating in the HIGH altitude Cardiovascular Research Alps project were randomized to acetazolamide (250 mg x2/die) (ACZ) or placebo (PL). During the expedition we performed nocturnal cardiorespiratory polysomnography during the second night at Capanna Margherita Hut 4554 m above SL). Results: During night at 4554 m apnea-hypopnea index (AHI) was 40.87+ 27.83 events/h in male PL, 3.77+ 3.8 events/h in male ACZ, 7.33+3.99 events/h in female PL and 2.92+ 3.52 events/h in female ACZ. The mean SaO2 during the night is significantly higher both in males than in females with ACZ as compared with PL groups (p