Tobacco smoking has been a recognized risk factor for cardiovascular diseases (CVD). Smoking is a chronic relapsing disease and pharmacotherapy is a main component of smoking cessation. Obstructive sleep apnea (OSA) and smoking both increase the risk of CVD and are associated with significant morbidity and mortality. There are few existing data examining how pharmacological treatment, such as nicotine replacement therapy (NRT), bupropion, and varenicline, affect smokers suffering with OSA and especially their cardiovascular effects. The aim of this review was to evaluate the effects of smoking cessation pharmacotherapy on OSA with a special emphasis on the cardiovascular system. Results: Only small studies have assessed the effect of NRTs on OSA. Nicotine gum administration showed an improvement in respiratory events but with no permanent results. No specific studies were found on the effect of bupropion on OSA, and a limited number evaluated varenicline's effects on sleep and specifically OSA. Varenicline administration in smokers suffering from OSA reduced the obstructive respiratory events, especially during REM. Studies on second-line medication (nortriptyline, clonidine, cytisine) are even more limited. There are still no studies evaluating the cardiovascular effects of smoking cessation medications on OSA patients. Conclusions: Sleep disturbances are common withdrawal effects during smoking cessation but could be also attributed to pharmacotherapy. Smokers should receive personalized treatment during their quitting attempts according to their individual needs and problems, including OSA. Future studies are needed in order to evaluate the efficacy and safety of smoking cessation medications in OSA patients.
Background: The 4-Variable screening tool (4-V) was developed and validated in Japan from Takegami et al as a tool for the identification of Obstructive Sleep Apnea Syndrome (OSAS). Objectives: To evaluate the ability of the 4-V to estimate the incidence of OSAS as measured by Apnea Hypopnea Index (AHI) in a European Population as the antropometric data differ between race (caucasian-asian). Methods: The risk of OSAS was calculated by the 4-V tool in 1057 patients visiting a sleep clinic in Greece. All patients underwent polysomnography (PSG). Results: The mean age of patients (73.8%male) was 52±14 yr, BMI 32.9±7 kg/ m2, neck circumference 41.75±4.3 cm, Epworth Sleepiness Scale (ESS) 11.5±5.4, Apnea Hypopnea Index (AHI) 32.7±26.5/h, Oxygen Desaturation Index (ODI) 37.7±29.6 and 4-V score 13.3±2.5. OSAS was diagnosed with PSG in 849(80.3%) patients: 13.6% mild, 19.1% moderate,47.6% severe. By 4-V (≥14) 45.1% (477) of patients were classified as being at high risk of OSAS. The sensitivities of 4-V for AHI ≥5, ≥ 15 and ≥ 30 were 50.7%, 54.9% and 61%, respectively; the specificities 78%,74.4%,69.3%; the positive predictive values 90.3%, 81.1%, 64.3%; the negative predictive values 27.9%, 45.1% and 66.2%. The area under the ROC curve at AHI≥ 5 was 0.68. Conclusions: In a European population 4-V may miss cases suffering from OSAS (relatively low sensitivity) but it has good specificity classifying fewer normal persons as high-risk for OSAS.
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