Athanasia Pataka

G. Papanikolaou General Hospital

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Ludger Grote

Sahlgrenska University Hospital

ÖK

Özen K. Başoğlu

Ege University

Serafeim‐Chrysovalantis Kotoulas

Aristotle University of Thessaloniki

Paraskevi Argyropoulou

Aristotle University of Thessaloniki

Paschalis Steiropoulos

Democritus University of Thrace

Johan Verbraecken

Antwerp University Hospital

Izolde Bouloukaki

University of Crete

Jan Hedner

University of Gothenburg

Maria R. Bonsignore

Ospedale Vincenzo Cervello

Sophia Schiza

University of Crete

Cooperative Institutions

Aristotle University of Thessaloniki

278

G. Papanikolaou General Hospital

179

Democritus University of Thrace

106

National and Kapodistrian University of Athens

106

AHEPA University Hospital

University Hospital of Alexandroupolis

Sotiria General Hospital

University of Crete

Papageorgiou General Hospital

Ippokrateio General Hospital of Thessaloniki

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Obstructive Sleep Apnea and Smoking Increase the Risk of Cardiovascular Disease: Smoking Cessation Pharmacotherapy

Journal of Clinical Medicine (2023)

Athanasia Pataka Serafeim‐Chrysovalantis Kotoulas Aliki Karkala Asterios Tzinas George Kalamaras

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.

Varenicline

Bupropion

Pharmacotherapy

Nicotine replacement therapy

10.3390/jcm12247570

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Citations (2)

Unique sleep‐stage transitions determined by obstructive sleep apnea severity, age and gender

Journal of Sleep Research (2019)

Marcel Wächter Jan W. Kantelhardt Maria R. Bonsignore Izolde Bouloukaki P. Escourrou

Summary In obstructive sleep apnea, patients’ sleep is fragmented leading to excessive daytime sleepiness and co‐morbidities like arterial hypertension. However, traditional metrics are not always directly correlated with daytime sleepiness, and the association between traditional sleep quality metrics like sleep duration and arterial hypertension is still ambiguous. In a development cohort, we analysed hypnograms from mild ( n = 209), moderate ( n = 222) and severe ( n = 272) obstructive sleep apnea patients as well as healthy controls ( n = 105) from the European Sleep Apnea Database. We assessed sleep by the analysis of two‐step transitions depending on obstructive sleep apnea severity and anthropometric factors. Two‐step transition patterns were examined for an association to arterial hypertension or daytime sleepiness. We also tested cumulative distributions of wake as well as sleep‐states for power‐laws (exponent α) and exponential distributions (decay time τ) in dependency on obstructive sleep apnea severity and potential confounders. Independent of obstructive sleep apnea severity and potential confounders, wake‐state durations followed a power‐law distribution, while sleep‐state durations were characterized by an exponential distribution. Sleep‐stage transitions are influenced by obstructive sleep apnea severity, age and gender. N2 → N3 → wake transitions were associated with high diastolic blood pressure. We observed higher frequencies of alternating (symmetric) patterns (e.g. N2 → N1 → N2, N2 → wake → N2) in sleepy patients both in the development cohort and in a validation cohort ( n = 425). In conclusion, effects of obstructive sleep apnea severity and potential confounders on sleep architecture are small, but transition patterns still link sleep fragmentation directly to obstructive sleep apnea‐related clinical outcomes like arterial hypertension and daytime sleepiness.

Sleep Stages

Epworth Sleepiness Scale

Sleep

10.1111/jsr.12895

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Citations (16)

CPAP for secondary cardiovascular prevention in obstructive sleep apnoea patients: not only one moon, but many stars

Breathe (2022)

Sébastien Baillieul Neeraj Shah Rivindi Dharmasena Sophia Schiza Dries Testelmans

While continuous positive airway pressure (CPAP) therapy has a strong evidence base for the treatment of obstructive sleep apnoea (OSA), its impact on cardiovascular comorbidity remains unclear. This journal club reviews three recent randomised controlled trials aimed to evaluate the impact of CPAP therapy in secondary prevention of cerebrovascular and coronary heart disease (SAVE trial), comorbid coronary heart disease (RICCADSA trial) and in patients admitted with acute coronary syndrome (ISAACC trial). All three trials included patients with moderate-to-severe OSA and excluded patients with severe daytime sleepiness. When CPAP was compared with usual care, they all reported no difference in a similar primary composite end-point including death from cardiovascular disease, cardiac events, and strokes. These trials faced the same methodological challenges, including a low primary end-point incidence, the exclusion of sleepy patients, and a low CPAP adherence. Therefore, caution must be taken when broadening their results to the wider OSA population. Although randomised controlled trials provide a high level of evidence, they may not be sufficient to capture the diversity of OSA. Large-scale, real-world data may be able to provide a more rounded and generalisable picture of the effects of routine clinical use of CPAP on cardiovascular morbimortality.

Clinical endpoint

10.1183/20734735.0148-2022

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Quality of Life and Public Health Issues in Patients Suffering from Obstructive Sleep Apnea Syndrome

Journal of Sleep Disorders & Therapy (2013)

Athanasia Pataka

Quality of Life (QoL) in patients with Obstructive Sleep Apnea Syndrome (OSAHS) is substantially reduced. OSAHS is as an important cause of morbidity and mortality as it is associated with a wide range of medical consequences (hypertension, cardiovascular diseases, psychological effects) and also accidents. Sleepiness, depression, fatigue and obesity have an important impact on QoL. Patients report problems in their social, professional and sexual relationships. Effective treatment of sleep apnea can improve the QoL of the patients and their families. As we live in an era of economic crisis cost effectiveness is crucial and in OSAHS the application of treatment with Continuous Positive Airway Pressure (CPAP) results in a significant reduction in healthcare costs, accidents and in an improvement of QoL of individuals and of society. This review focuses on the impact of OSAHS on quality of life and public health issues and the effectiveness of OSAHS treatment in these aspects.

10.4172/2167-0277.1000114

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The financial crisis has an impact in sleep medicine: experience of a sleep clinic in Greece

Sleep And Breathing (2013)

Athanasia Pataka Nikolaos Chavouzis Katalin Fekete Passa Georgia Pitsiou Paraskevi Argyropoulou

Sleep medicine

Sleep

10.1007/s11325-013-0838-z

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Citations (4)

Sleep apnea patients report neglected care during COVID-19 pandemic

Christina Alexopoulou Dimitrios Kyrou Dimitra Tsakona Dimitra Siopi Anastasia Amfilochiou

Introduction: COVID-19 pandemic had a major impact on the capacity of the health care system. Chronic patients were advised to contact clinical settings only in case of emergency. The aim of our study is to evaluate whether this situation led to a neglected care pattern in Sleep Apnea Patients (SAP) and the physical and psychological consequences potentially ensuing. Method: Data was collected from the Greek Sleep Apnea Patient Cohort. A purpose built questionnaire was administered to 137 Sleep Apnea adult Patients on Positive Airway Pressure therapy at the first follow up visit after the pandemic first strict lockdown from March to May 2020. Results: We collected 137 questionnaires. Patients' mean age was 59±11 and 64% were male. From March to May 2020, only 19% seeked medical care. 11% visited their NHS doctor and 8% private care. 41% adopted the newly introduced contactless e-prescription system in order to be able to continue the PAP therapy, avoiding their scheduled in person visit. Losing direct contact with their doctor negatively affected them emotionally (40%). Common symptoms among our population were stress (49,4%), bad mood (45,2%), insecurity (36%) and irritation (35%). 71.5 % had at least one and 39,4% more than three reported psychological symptoms. Conclusion: Covid-19 pandemic and its impact on the healthcare system definitely affected our population. A neglected care pattern is identified in Sleep Apnea Patients, clearly revealing psychological consequences. The extended use of e-prescription shows that patients are able to adopt novel types of communication with healthcare providers. The development of e-health tools may facilitate the follow up of Sleep Apnea Patients.

Pandemic

10.1183/13993003.congress-2021.pa2085

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Tyrosine Kinase Inhibitors for the Elderly

Journal of Cancer (2016)

Wolfgang Hohenforst‐Schmidt Paul Zarogoulidis Michael Steinheimer Naim Benhassen Theodora Tsiouda

Until few years ago non-specific cytotoxic agents were considered the tip of the arrow as first line treatment for lung cancer.However; age > 75 was considered a major drawback for this kind of therapy.Few exceptions were made by doctors based on the performance status of the patient.The side effects of these agents are still severe for several patients.In the recent years further investigation of the cancer genome has led to targeted therapies.There have been numerous publications regarding novel agents such as; erlotinib, gefitinib and afatinib.In specific populations these agents have demonstrated higher efficiency and this observation is explained by the overexpression of the EGFR pathway in these populations.We suggest that TKIs should administered in the elderly, and with the word elderly we propose the age of 75.The treating medical doctor has to evaluate the performance status of a patient and decide the best treatment in several cases indifferent of the age.TKIs in most studies presented safety and efficiency and of course dose modification should be made when necessary.Comorbidities should be considered in any case especially in this group of patients and the treating physician should act accordingly.

Afatinib

10.7150/jca.14819

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Citations (16)

Continuous Positive Airway Pressure and Cardiovascular Events in Patients with Obstructive Sleep Apnea

Current Cardiology Reports (2013)

Athanasia Pataka Renata L. Riha

Positive airway pressure

10.1007/s11886-013-0385-z

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Validation of the four -variable screening tool in a European population for assessing obstructive sleep apnea syndrome

European Respiratory Journal (2013)

Athanasia Pataka Nikolaos Chavouzis Katalin Fekete Passa Asimina Paspala Evdokia Sourla

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.

Epworth Sleepiness Scale

Hypopnea

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Smoking of healthcare workers(HCWs) working in reference hospitals during the first wave of the COVID-19 pandemic

Nikolaos Athanasiou Sofia Pappa Dimitra Mpousiou Stamatoula Tsikrika Zafeiria Barmparessou

Introduction-Goal: To investigate addiction and mental health in HCWs working in COVID-19 reference hospitals during the first wave in Greece Method: The study was conducted in 7 reference hospitals for SARSCoV2. Online questionnaires were created via GoogleForms and they were sent to the participants through e-mail and social media applications.464HCWs were includedTab1 Results:a)HCWs smoke at 33,41%(19,18%ex-smokers). Doctors, nurses and rest HCWs smoking percentagesFig1 b) Most HCWs use classic cigarettesTab2 c) 9% of HCWs increased daily consumption of cigarettes during the pandemic d) Smokers HCWs experience depression(PHQ-9Scale)in 36,5% and stress disorders(GAD-7Scale)in 37% Fig2,3 e) Compliance with quarantine rules was higher in never smokers and in those without predisposing factorsFig4 f) Commorbidities were presented in 36% of smokers and 24% of ex-smokersFig5 Conclusion: A high percentage of HCWs working in COVID-19 reference hospitals, continued or even increased daily consumption of cigarettes during the first wave of Covid-19 pandemic. They also experienced higher rates of depression and stress compared to never-smokers and demonstrated a worse compliance with imposed quarantine rules. We suggest the creation of holistic smoking cessation centers that include depression and stress management of HCWs in order to achieve smoke-free hospitals worldwide and support HCWs9 psychological burden

Pandemic

Depression

10.1183/13993003.congress-2021.pa3200

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