The European Sleep Apnoea Database (ESADA): report from 22 European sleep laboratories.

The European Sleep Apnoea Database (ESADA) reflects a network of 22 sleep disorder centres in Europe enabled by a COST action B26 programme. This ongoing project aims to describe differences in standard clinical care of patients with obstructive sleep apnoea (OSA) and to establish a resource for genetic research in this disorder. Patients with suspected OSA are consecutively included and followed up according to local clinical standards. Anthropometrics, medical history, medication, daytime symptoms and sleep data (polysomnography or cardiorespiratory polygraphy) are recorded in a structured web-based report form. 5,103 patients (1,426 females, mean±sd age 51.8±12.6 yrs, 79.4% with apnoea/hypopnoea index (AHI) ≥5 events·h(-1)) were included from March 15, 2007 to August 1, 2009. Morbid obesity (body mass index ≥35 kg·m(-2)) was present in 21.1% of males and 28.6% of females. Cardiovascular, metabolic and pulmonary comorbidities were frequent (49.1%, 32.9% and 14.2%, respectively). Patients investigated with a polygraphic method had a lower AHI than those undergoing polysomnography (23.2±23.5 versus 29.1±26.3 events·h(-1), p<0.0001). The ESADA is a rapidly growing multicentre patient cohort that enables unique outcome research opportunities and genotyping. The first cross-sectional analysis reveals a high prevalence of cardiovascular and metabolic morbidity in patients investigated for OSA.

Management of obstructive sleep apnea in Europe.

OBJECTIVES: In Europe, the services provided for the investigation and management of obstructive sleep apnoea (OSA) varies from country to country. The aim of this questionnaire-based study was to investigate the current status of diagnostic pathways and therapeutic approaches applied in the treatment of OSA in Europe, qualification requirements of physicians involved in diagnosis and treatment of OSA, and reimbursement of these services. METHODS: Two questionnaires were sent to 39 physicians in 22 countries in Europe. In order to standardize the responses, the questionnaire was accompanied by an example. RESULTS: Sleep centers from 21 countries (38 physicians) participated. A broad consistency among countries with respect to the following was found: pathways included referral to sleep physicians/sleep laboratories, necessity for objective diagnosis (primarily by polysomnography), use of polygraphic methods, analysis of polysomnography (PSG), indications for positive airway pressure (PAP) therapy, application of standard continuous PAP (CPAP) therapy (100% with an CPAP/APAP ratio of 2.24:1), and the need (90.5%) and management of follow-up. Differences were apparent in reimbursement of the diagnostic procedures and follow-up, in the procedures for PAP titration from home APAP titration with portable sleep apnea monitoring (38.1%) up to hospital monitoring with PSG and APAP (85.7%), and in the qualification requirements of sleep physicians. CONCLUSIONS: Management of OSA in different European countries is similar except for reimbursement rules, qualification of sleep specialists and procedures for titration of the CPAP treatment. A European network (such as the one accomplished by the European Cooperation in Science and Technology [COST] B26 Action) could be helpful for implementing these findings into health-service research in order to standardize management in a cost effective perspective.

A new technique for arthroscopic resection of a bucket handle tear.

The authors present a previously undescribed technique for excision of a bucket handle tear. The technique uses a Caspari suture punch to pass a suture through the meniscus and use the suture as a tool to maneuver the meniscus so that its posterior horn attachment can be cut. The technique is noteworthy in that it eliminates the need for establishing an additional portal.

[The chronotropic reaction and the dynamics of the blood supply to the forearm during modulation of the baroreceptor reflex activity in patients with arterial hypertension]. / Khronotropnaia reaktsiia i dinamika krovosnabzheniia predplech'ia pri moduliatsii aktivnosti baroretseptornogo refleksa u bol'nykh s arterial'noi gipertenziei.

Original method of baroreflex activation and deactivation was described. Bradycardia and vasodilatation of the forearm vessels were observed at baroreflex activation. Tachycardia and forearm blood flow reduction were observed at baroreflex deactivation. The sensitivity of baroreflex heart component vas shown to depend upon the arterial pressure and a baseline cardiac cycle duration in both normo- and hypertensive subjects.

Management of essential hypertension in patients with different degrees of left ventricular hypertrophy. Multicenter trial.

Three hundred and four hypertensive patients with different degrees of left ventricular hypertrophy (LVH) were recruited and followed for 4 years. The patients were randomized into two groups: Group I (150 patients) was treated with a combination of hypotensive drugs including beta-blockers, and group II (154 patients) was treated with the same combination of drugs including diuretics instead of beta-blockers. By the end of the fourth year, 60 endpoints were recorded: 17 strokes, 13 myocardial infarctions, and 30 cases of chronic coronary insufficiency. Mortality was statistically higher in group II (7 of 154 or 5% v 1 of 150 or 1%) (P less than .035), but there was no difference between the groups in the incidence of nonfatal endpoints. These data confirm that beta-blockers can reduce mortality associated with the complications presented in hypertensive patients. Increased left ventricular myocardial mass (greater than 200 g, according to Teichholz' formula) was shown to have prognostic value for the development of complications. In patients with LVMM greater than 200 g, the probability of fatal complications was higher (P less than .007), as was the probability of nonfatal myocardial infarction (P less than .01), development of coronary artery disease (P less than .02), and all complications (P less than .0003). Regression of LVH to less than 200 g (according to Teichholz' formula) improved prognosis.

Haemodynamic resistance of forearm vessels during prolonged drug treatment of essential hypertension.

In 40 patients with essential hypertension, the authors studied the haemodynamic resistance in forearm vessels before and after 15-min arterial occlusion, and changes in this parameter during a three-year combined antihypertensive treatment. The study revealed that the 15-min occlusion did not entirely suppress the contractile activity of vascular smooth muscles. Under these conditions, the minimum vascular resistance reflects the sum of structural and functional alterations. The character of change in minimal haemodynamic vascular resistance depends on the mechanism of action of the antihypertensive drugs. Administration of the post-synaptic alpha-adrenergic blocker Pratsiol produces a decrease in the minimal haemodynamic vascular resistance.

Increased blood kynurenine level as a factor inhibiting the therapeutic effect of antihypertensive agents in combined long-term treatment of essential hypertension.

Results of a three-year antihypertensive combined treatment of 24 male patients with essential hypertension aged 35-55 years are presented. In all patients the blood serum kynurenine level after tryptophan load was determined before treatment and after the 1st, 2nd and 3rd years of therapy. It was found that in a part of patients the long-term administration of antihypertensive drugs led to an increased accumulation of kynurenine as a manifestation of pyridoxal-5-phosphate deficiency. The development and preservation of an increased blood kynurenine level interferes with the positive effects of antihypertensive therapy as regards both blood pressure and left ventricular myocardial mass reduction.

The development of coronary insufficiency during prolonged treatment of essential hypertension.

The occurrence of signs of coronary insufficiency during prolonged combined treatment of essential hypertension was analysed in a selected group of 42 patients with left ventricular myocardial hypertrophy. During a four-year antihypertensive therapy 17% of patients developed angina pectoris on effort myocardial infarction occurred in 7%, and ischaemic ECG changes during bicycle ergometry or transoesophageal atrial pacing were detected in 36%. In the subgroup with an insufficient hypotensive effect and sustained severe myocardial hypertrophy the signs of coronary insufficiency occurred in 53%. Nevertheless, the attainment of a stable pressure normalization and regression of myocardial hypertrophy does not exclude the development of coronary insufficiency, even in patients treated with beta-adrenoblocking drugs.

[Correlation of functional and structural changes of the cardiovascular system in hypertensive disease]. / Sootnoshenie funktsional'nykh i strukturnykh izmenenii serdechno-sosudistoi sistemy pri gipertonicheskoi bolezni.

Dynamics of left ventricular mass, minimal resistance of forearm arterial vessels and compliance of forearm venous vessels were studied in hypertensive patients during a 3-year effective antihypertensive treatment. Our findings suggest that pressure reduction and regression of myocardial hypertrophy develop in a parallel fashion while minimal resistance of vessels remains elevated due to the increasing contractile activity of smooth muscles. The presence of structural changes can only be assessed if the transmural pressure is the same along the whole arterial tree.

[Changes in local blood flow and energy metabolism in patients with hypertension with different degrees of tolerance of isometric load (hand grip)]. / Izmeneniia lokal'nogo krovotoka i energeticheskogo metabolizma u bol'nykh gipertonicheskoi bolezn'iu s razlichnoi tolerantnost'iu k izometricheskoi nagruzke (kistevoi zhim).

The onset of muscular fatigue and the patterns of exercise and postcontraction hyperemia, oxygen consumption and lactate release were examined in 50 male patients with essential hypertension, doing hand grip with an effort amounting to 5% of their maximum unrestricted potential. Subgroups of patients with normal and rapid onset of forearm muscular fatigue were identified. Unlike normal subjects and hypertensive patients with normal onset of muscular fatigue, patients with increased muscular fatigability demonstrated a progressive increase rather than stabilization of blood flow rate, oxygen consumption and lactate release which continued until the patient gave up exercise. Different patterns of blood supply, energy metabolism and muscular fatigability are believed to result from changed vascular resistance.

[Dynamics of the carotid baroreflex and of blood catecholamines during hand press]. / Dinamika karotidnogo barorefleksa i katekholaminov krovi vo vremia kistevogo zhima.

To evaluate the contribution of cortical and peripheral reflexes in originating pressor reaction, the carotid baroreceptor and sympatho-adrenal activity (according to plasma noradrenaline, adrenaline and dopamine levels) were studied during voluntary handgrip. Differences were found in the pattern of adrenergic responses during and after contraction when only muscle blood receptors were activated by the products of anaerobic metabolism. The data indicate that the inhibition of a heart component of carotid baroreceptor is related to central motor command.