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Biomedical subjects

Alberto Braghiroli

Publications and source records attributed to Alberto Braghiroli.

6 recordsLinked to original sources
PubMed2005

Sleep and exertional periodic breathing in chronic heart failure: prognostic importance and interdependence.

BACKGROUND: Sleep and exertional periodic breathing are proverbial in chronic heart failure (CHF), and each alone indicates poor prognosis. Whether these conditions are associated and whether excess risk may be attributed to respiratory disorders in general, rather than specifically during sleep or exercise, is unknown. METHODS AND RESULTS: We studied 133 CHF patients with left ventricular ejection fraction (LVEF) < or =40%. During 1170+/-631 days of follow-up, 31 patients (23%) died. Nonsurvivors had higher New York Heart Association class, ventilatory response (ve/vco2 slope), and apnea-hypopnea index (AHI) and lower peak vo2 (all P<0.01); lower LVEF and prescription of beta-blockers, and shorter transmitral deceleration time (all P<0.05). Exertional oscillatory ventilation (EOV), established by cyclic fluctuations in minute ventilation that persisted for > or =60% of exercise duration with an amplitude > or =15% of the average resting value, was significantly more frequent in nonsurvivors (42% versus 15%, P<0.01). Multivariable analysis selected AHI (hazard ratio [HR] 5.66, 95% CI 2.3 to 19.9, P<0.01), peak vo2 (HR 0.93, 95% CI 0.90 to 0.97, P<0.01), and beta-blocker prescription (HR 0.34, 95% CI 0.13 to 0.87, P<0.05) as predictors of cardiac events. The best cutoff for AHI was >30/h. EOV was significantly related to AHI >30/h (chi2 14.6, P<0.01): 78% of EOV patients showed AHI >30/h. Multivariable analysis, including breathing disorders alone (EOV, AHI >30/h) or in combination (EOV plus AHI >30/h), selected combined disorders as the strongest predictor of events (HR 6.65, 95% CI 2.6 to 17.1, P<0.01). CONCLUSIONS: In CHF, EOV is significantly associated with AHI >30/h. Although each breathing disorder alone is linked to total mortality, their combination has a crucial prognostic burden.

Aged↗
PubMed2003

Central sleep apnea in left ventricular dysfunction: prevalence and implications for arrhythmic risk.

BACKGROUND: The prevalence and characteristics of sleep-disordered breathing in patients with asymptomatic left ventricular (LV) dysfunction are unknown. Therefore, we evaluated the prevalence of sleep-disordered breathing in patients with LV dysfunction without overt heart failure and tested the hypothesis that sleep-disordered breathing is linked to greater hemodynamic and autonomic impairment. METHODS AND RESULTS: We studied 47 patients with LV ejection fractions or=15/h, was present in 26 patients (55%), 17 (36%) of whom had severe CSA (apnea-hypopnea index >or=30/h). Obstructive sleep apnea was evident in 5 patients (11%). The prevalence and severity of CSA were higher in patients with ischemic cardiomyopathy than in patients with nonischemic cardiomyopathy (P<0.05). Exercise tolerance and echocardiographic indices of systolic and diastolic function were similar in patients without CSA, with mild CSA, and with severe CSA. Heart rate variability was markedly depressed in patients with CSA (P<0.05). Patients with severe CSA also had a higher incidence of nonsustained ventricular tachycardia (P=0.05). CONCLUSIONS: CSA is highly prevalent in patients with asymptomatic LV dysfunction. The severity of CSA may not be related to the severity of hemodynamic impairment. Severe CSA is associated with impaired cardiac autonomic control and with increased cardiac arrhythmias.

Arrhythmias, Cardiac↗
PubMed2002

Sleep disordered breathing and COPD.

This issue of Sleep and Breathing presents a section on sleep in COPD, a widespread disease consuming many health resources which is often diagnosed so late that little chance of reversibility remains. The early detection of the warning clinical signs can include sleep studies, mainly in the presence of arterial carbon dioxide levels higher than expected from pulmonary function tests. Two of the articles deal with hypercapnia and nocturnal hypoventilation in COPD; the third underlines the impact of tobacco smoking on snoring and on oxygen availability to tissues, showing a poor reliability of pulse oximetry in subjects with heavy smoking habits.

Humans↗
PubMed2002

Nocturnal desaturations in COPD: still an open question?

The relevance of sleep oxyhemoglobin desaturations in COPD patients is still a matter of debate. The best definition for clinical outcomes is the occurrence of episodes lasting at least 5 minutes and reaching SaO2 levels less than or equal to 85%. Focusing on longer and milder episodes (at least 30% of the night with SaO2 < 90%) did not provide clinical relevance. One possible consequence of desaturation episodes could be a worsening of pulmonary hemodynamics, but O2 dips could just be a marker of a mechanical derangement associated with a worse prognosis. Data confirming the association of these episodes with the clinical type of COPD and with inflammatory mediator modulation are still lacking.

Circadian Rhythm↗