Sleep Apnea Syndromes: Cirignotta F

Villa MP, Brunetti L, Bruni O, Cirignotta F, Cozza P, Donzelli G, Ferini Strambi L, Levrini L, Mondini S, Nespoli L, Nosetti L, Pagani J, Zucconi M, Anonymous00069. · Gruppo di Studio interdisciplinare disturbi respiratori nel sonno, Società Italiana di Pediatria, Rome, Italy. · Minerva Pediatr. · Pubmed #15252374 links to  free full text

This publication has no abstract.

Ferretti A, Giampiccolo P, Redolfi S, Mondini S, Cirignotta F, Cavalli A, Tantucci C. · Division of Pneumology, S. Orsola-Malpighi Hospital, Bologna, Italy. · Respir Res. · Pubmed #16573817 links to  free full text

Abstract: BACKGROUND: The ability of negative expiratory pressure (NEP) technique to differentiate between awake snorers with and without obstructive sleep apnea-hypopnea (OSAH) was investigated. METHODS: Forty-eight subjects with sleep disordered breathing (SDB) and 7 healthy subjects, as non-snorer controls, underwent the NEP application of -5 and -7 cmH2O in the seated and supine position during wakefulness, after performing a sleep study. The upper airway collapsibility was assessed by computing the volume exhaled during the first 0.5 sec. (V,NEP0.5) and 1 sec. (V,NEP1) following the NEP start. RESULTS: Patients with severe (AHI > or = 30) (n = 19) and mild-to-moderate (AHI <30 and >5) (n = 15) OSAH had lower V,NEP0.5 (340 +/- 88 ml) as compared to snorers (AHI < or = 5) (n = 14) (427 +/- 101 ml; p < 0.01) and controls (n = 7) (492 +/- 69 ml; p < 0.001) in the supine position with NEP -5 cmH2O. Less significant differences among the different groups were observed for V,NEP0.5 in the seated position with NEP -5 cmH2O and in both positions with NEP -7 cmH2O (only OSAH patients vs controls, p < 0.001). Similar results were obtained for V,NEP1 in either position by using both NEP -5 cmH2O and -7 cmH2O. In spite of this, a substantial overlapping of V,NEP0.5 and V,NEP1 between snorers and OSAH patients did not allow to identify a reliable diagnostic cut-off level. An inverse correlation with AHI was found for V,NEP0.5 in the supine position with NEP -5 cmH2O (rs = -0.46, p < 0.05) in severe OSAH patients. CONCLUSION: The awake OSAH patients exhibit values of V,NEP0.5 and V,NEP1 lesser than those of awake snorers. The NEP technique, however, appears to have a limited usefulness as clinical tool for routine screening of the OSAH patients during wakefulness.

Cirignotta F, Mondini S, Gerardi R, Mostacci B, Sancisi E. · Sleep Medicine Unit, Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. · Chest. · Pubmed #11348943 links to  free full text

Abstract: BACKGROUND: Portable devices are used for unattended recording of patients with suspected obstructive sleep apnea syndrome (OSAS). The MESAM 4 (MAP; Martinsried, Germany) is a computerized ambulatory polysomnographic system that records four parameters: breathing noise, heart rate, arterial oxygen saturation (SaO(2)), and body position. Design and method: We evaluated the reliability of the oxygen desaturation index (ODI) automatically calculated by the MESAM 4 device in evaluating patients with "complicated" OSAS. These patients present SaO(2) drops due to apneas associated with a fall in baseline SaO(2) during sleep, as occurs in the "overlap syndrome." Ten patients with complicated OSAS underwent nocturnal MESAM 4 recordings, and we compared the visual and automatic scorings of the ODI. RESULTS: The ODI obtained with visual scoring was significantly higher than ODI automatically calculated by the MESAM 4 in all patients. In some patients, this difference was so significant that it could bias clinical judgment of OSAS severity. We demonstrated that the system did not identify those desaturation events that were superimposed on a fall in baseline SaO(2). The error depends on the algorithm by which the device recognizes the desaturation events and calculates the baseline SaO(2). CONCLUSION: Automatic analysis of MESAM 4 recordings may be misleading in evaluating OSAS patients who have a fall in baseline SaO(2) during sleep. In this case, visual scoring performed by a trained polysomnographer is recommended.

Pizza F, Contardi S, Mondini S, Trentin L, Cirignotta F. · Unit of Neurology, S. Orsola-Malpighi Hospital, Bologna, Italy. · Sleep. · Pubmed #19294958 No free full text.

Abstract: STUDY OBJECTIVES: To test the reliability of a driving-simulation test for the objective measurement of daytime alertness compared with the Multiple Sleep Latency Test (MSLT) and with the Maintenance of Wakefulness Test (MWT), and to test the ability to drive safely, in comparison with on-road history, in the clinical setting of untreated severe obstructive sleep apnea. DESIGN: N/A. SETTING: Sleep laboratory. PATIENTS OR PARTICIPANTS: Twenty-four patients with severe obstructive sleep apnea and reported daytime sleepiness varying in severity (as measured by the Epworth Sleepiness Scale). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Patients underwent MSLT and MWT coupled with 4 sessions of driving-simulation test on 2 different days randomly distributed 1 week apart. Simulated-driving performance (in terms of lane-position variability and crash occurrence) was correlated with sleep latency on the MSLT and more significantly on the MWT, showing a predictive validity toward the detection of sleepy versus alert patients with obstructive sleep apnea. In addition, patients reporting excessive daytime sleepiness or a history of car crashes showed poorer performances on the driving simulator. CONCLUSIONS: A simulated driving test is a suitable tool for objective measurement of daytime alertness in patients with obstructive sleep apnea. Further studies are needed to clarify the association between simulated-driving performance and on-road crash risk of patients with sleep disordered breathing.

Pizza F, Contardi S, Ferlisi M, Mondini S, Cirignotta F. · Unit of Neurology, S.Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy. · Accid Anal Prev. · Pubmed #18329412 No free full text.

Abstract: BACKGROUND: Sleepiness related car accidents are common in obstructive sleep apnoea syndrome (OSAS) patients. The objective measurements of sleepiness used in clinical setting quantify the tendency to fall asleep in quiet situations that are completely different from driving. METHODS: We studied 30 OSAS patients with subjective (subjective sleepiness scales) and objective (multiple sleep latency test, MSLT) sleepiness measurements, associated with driving simulation test (DST), previously validated in young healthy subjects. The results of subjective and objective sleepiness tests were compared with simulated driving performance in order to evaluate the suitability of our DST for measuring alertness. RESULTS: Subjective and objective sleepiness measurements were significantly correlated with driving performance on the simulator. The most significant correlates of sleepiness were the measures of the primary vehicle control task on the simulator: lane position variability and crash data. The comparison of DST and MSLT results suggested our driving simulated approach could be used to evaluate daytime sleepiness in the clinical setting of OSAS patients. CONCLUSIONS: Our DST is a suitable objective tool to detect sleepiness in OSAS patients, and could be useful in the clinical setting of sleep medicine and research.

Sorrenti G, Piccin O, Scaramuzzino G, Mondini S, Cirignotta F, Ceroni AR. · Department of Surgical Science and Reanimation, "S Orsola-Malpighi" Hospital, Italy. · Acta Otorhinolaryngol Ital. · Pubmed #15688905 No free full text.

Abstract: Surgical treatment for retro-lingual obstruction in patients suffering from obstructive sleep apnea syndrome remains a problem for which there is no simple solution. The techniques most in use (tongue suspension, genioglossal advancement with hyoid suspension) are effective primarily as stabilization methods modifying neither tongue position, nor volume and only produce appreciable results when performed on non-overweight patients with respiratory disturbance index <40. For patients suffering from severe obstructive sleep apnoea syndrome in whom the most obvious morphological alteration is the presence of hypo-pharyngeal obstruction due to tongue base hypertrophy, who are overweight or suffering from moderate obesity, a surgical procedure aimed at reducing tongue volume and at repositioning the hyoid bone, even if invasive, leads to a favourable outcome. Herein, personal experience is described in a group of 8 patients presenting severe obstructive sleep apnoea syndrome incompatible with normal quality of life and normal life expectancy (mean respiratory disturbance index = 55.1) who underwent surgical resection of the tongue base with hyoepiglottoplasty. This technique, first described by Chabolle, differs radically from others inasmuch as it guarantees enlargement of the hypo-pharyngeal lumen and remodelling of the hyolingual complex. Using a suprahyoid cervical approach, it is possible to effect ample reduction of the tongue base with amplification of the hypo-pharyngeal airway without inducing problems as far as concerns either swallowing or speech.

Cirignotta F. · Unit of Neurology, S. Orsola-Malpighi Hospital, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy. · Minerva Med. · Pubmed #15289747 links to  free full text

Abstract: Growing interest in sleep disorders has led to increased research in this direction. Increasingly sophisticated instrumental tests have disclosed new breathing patterns and complex syndromes. The initial identification of obstructive apneas was followed by studies characterizing snoring, hypopneas, respiratory effort-related arousal and flow limitation events. Since Pickwickian syndrome, an historical term currently deemed obsolete and confusing, sleep investigations have differentiated secondary hypoventilation, central hypoventilation and syndromes resulting from narrowing of the upper airways (snoring, upper airway resistance syndrome, obstructive sleep apnea-hypopnea syndrome). Inevitably, this has given rise to some confusion in the classification of events and syndromes which recent studies have attempted to clarify.

Manconi M, Mondini S, Fabiani A, Rossi P, Ambrosetto P, Cirignotta F. · Units of Neurology, St Orsola-Malpighi Hospital, Bologna, Italy. · Arch Neurol. · Pubmed #14676058 links to  free full text

Abstract: BACKGROUND: Anterior spinal artery (ASA) syndrome results in motor palsy and dissociated sensory loss below the level of the lesion, accompanied by bladder dysfunction. When the cervical spine is involved, breathing disorders may be observed. OBJECTIVE: To describe the polysomnographic findings in a patient with cervical ASA syndrome complicated by a sleep breathing disorder. SETTING: Unit of neurology at a sleep center.Patient A 30-year-old man had an ischemic lesion that affected the anterior cervical spinal cord (C2-C6) bilaterally because of an ASA thrombosis. He developed ASA syndrome associated with respiratory impairment during sleep. RESULTS: The polysomnographic study during sleep showed a severe sleep disruption caused by continuous central apneas that appeared immediately after falling asleep. Treatment by intermittent positive pressure ventilation normalized the respiratory pattern and sleep architecture. CONCLUSIONS: The sleep breathing pattern was compatible with central alveolar hypoventilation due to automatic breathing control failure caused by a lesion of the reticulospinal pathway, which normally activates ventilatory muscles during sleep. This autonomic sleep breathing impairment resembles that found as a complication in patients who undergo spinothalamic tract cervical cordotomy for intractable pain. This surgical complication is known as the Ondine curse.