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Obstructive sleep apnea and cancer: a complex relationship
Purpose of review Obstructive sleep apnea (OSA) has been recognized as a risk factor for cancer mainly through hypoxia, based on studies that did not distinguish among cancer types. The purpose of this review is to discuss the most recent data on epidemiology and pathophysiology of the OSA–cancer association. Recent findings According to epidemiological studies, OSA may have different influences on each type of cancer, either increasing or decreasing its incidence and aggressiveness. Time spent with oxygen saturation below 90% appears the polysomnographic variable most strongly associated with unfavorable effects on...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Alternative algorithms and devices in sleep apnoea diagnosis: what we know and what we expect
Purpose of review Diagnosis of sleep apnoea was performed in sleep laboratories with polysomnography. This requires a room with supervision and presence of technologists and trained sleep experts. Today, clinical guidelines in most countries recommend home sleep apnoea testing with simple systems using six signals only. If criteria for signal quality, recording conditions, and patient selection are considered, then this is a reliable test with high accuracy. Recent findings Recently diagnostic tools for sleep apnoea diagnosis become even more simple: smartwatches and wearables with smart apps claim to diagnose sleep a...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Does gender matter: sex-specific aspects of symptoms, outcome, and therapy of obstructive sleep apnea
Purpose of review Obstructive sleep apnea (OSA) has historically been considered as a male disease. As a result, female individuals with OSA were often under-diagnosed and under-treated compared with male individuals. However, recent data suggest that several OSA-associated adverse cardiovascular outcomes are more pronounced in women. Recent findings This review provides a summary of the most relevant recent evidence with regard to sex-specific OSA characteristics, including atypical symptoms, greater quality of life impairment and several more pronounced adverse outcomes in female individuals compared with male indiv...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Opioids and sleep
Purpose of review Summarize the effects of opioids on sleep including sleep architecture, sleep disordered breathing (SDB) and restless legs syndrome. Recent findings Opioids are associated with the development of central sleep apnea (CSA) and ataxic breathing. Recent reports suggest that adaptive servo-ventilation may be an effective treatment for CSA associated with opioids. Summary Opioids have multiple effects on sleep, sleep architecture and SDB. Although originally described with methadone use, most commonly used opioids have also been shown to affect sleep. In patients on chronic methadone, sleep architectur...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

New pharmacologic agents for insomnia and hypersomnia
Purpose of review Insomnia and hypersomnia are conditions with multifactorial causes that can be difficult to treat. There have been recent developments and changes in the treatment of both conditions, including the addition of some agents that have a novel mechanism of action. This review summarizes recent changes and highlights pertinent updates. Recent findings Benzodiazepine receptor agonists received a warning in 2019 regarding the possibility of complex sleep behaviors, such as sleepwalking. Zolpidem has been marketed in new dosage forms that include sublingual tablets and oral spray formulations. Orexin recepto...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Drug-induced sleep endoscopy: techniques, interpretation and implications
Purpose of review The purpose of this article is to highlight recent advances in the burgeoning field of drug-induced sleep endoscopy (DISE). Recent findings One of the first studies to investigate the correlation of DISE findings and natural sleep endoscopy found good agreement in clinically significant obstruction. Previous studies have shown good agreement of DISE findings with the use of different sedative agents implying that the choice of sedative may not be crucial. However, recent studies show variable patterns of collapse, especially at the tongue base, with the use of different sedative agents. A universally...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Respiratory and sleep-related complications of multiple system atrophy
Purpose of review The purpose of this article is to provide a contemporary review of sleep issues affecting patients with multiple system atrophy (MSA). Recent findings Prodromal symptoms of MSA may occur years prior to diagnosis, including autonomic dysfunction such as orthostatic hypotension, urogenital dysfunction, rapid eye movement (REM) sleep behavior disorder (RBD), and stridor. Patients may also develop sleep-related respiratory disorders such as obstructive sleep apnea (OSA), central sleep apnea (CSA), and stridor. The development of stridor is associated with a shortened lifespan and sudden death, which may ...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Endotypes and phenotypes in obstructive sleep apnea
Purpose of review The purpose of this review is to describe the variability of obstructive sleep apnea (OSA), both from a standpoint of underlying mechanisms and in terms of clinical manifestations. Recent findings Recent data suggest that not all patients with sleep apnea get their disease for the same reason. As such, no one variable is effective at defining which patients do or do not have sleep apnea. Identifying the mechanism(s) underlying OSA for an individual is helpful as it can help to determine whether personalized therapy could be developed based on an individual's characteristics. In addition, these underl...
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: SLEEP AND RESPIRATORY NEUROBIOLOGY: Edited by Lee Brown and Winfried Johannes Randerath Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Pulmonary Medicine)
Source: Current Opinion in Pulmonary Medicine - October 8, 2020 Category: Respiratory Medicine Tags: EDITORIAL INTRODUCTIONS Source Type: research

Looking into the future of sarcoidosis: what is next for treatment?
Purpose of review Sarcoidosis is a complex granulomatous disease of unknown cause. Corticosteroids and immune suppressants are often given long term in chronic disease, which may result in substantial toxicity. Validated strategies for selecting patients at risk for disease progression, who might benefit from early and targeted treatment, are lacking. Consequently, the unmet need for new treatment options in sarcoidosis is high. In this review, we critically discuss potential therapeutic targets and ongoing clinical trials in sarcoidosis. Recent findings Despite the heterogeneous clinical manifestations and the lack o...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Current treatment of sarcoidosis
Purpose of review Sarcoidosis is a granulomatous systemic disease of unknown cause where the lung is the most frequently affected organ. Therapeutic management of the disease is challenging as clinical presentation and prognosis are very heterogeneous. In the present review, we will summarize the main advances in sarcoidosis therapy. Recent findings Current sarcoidosis therapies are categorized in three lines: glucocorticoids (first line), immunosuppressants (second line), and biologics (third line). Recent glucocorticoid studies have reported that efficacy could be similar with high and low doses, but with an increas...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

An update on sarcoidosis-associated pulmonary hypertension
Purpose of review Pulmonary hypertension in sarcoidosis is a well known entity. Sarcoidosis-associated pulmonary hypertension (SAPH) incurs substantial morbidity and mortality. This review examines recent literatures published on epidemiology, prognosis and therapeutic management in SAPH. Recent findings Several registries have been published between 2017 and 2020. The consensus conclusion – SAPH is a harbinger for poor prognosis. Several factors were noted for predicting adverse outcome in SAPH like reduced 6-min walk distance and diffusing capacity for carbon monoxide. Given its adverse outcome, experts have now f...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Advanced pulmonary sarcoidosis
Purpose of review Mortality in patients with sarcoidosis has primarily been attributed to advanced pulmonary sarcoidosis. This review aims to provide an update on recent clinical studies that help to better phenotype these patients, discuss new treatment options, and suggest areas where additional research is needed. Recent findings Diagnosis and management of advanced pulmonary sarcoidosis has changed as new technologies and treatment options have emerged. Clinical phenotypes of advanced disease have evolved to show overlap in presentation with other interstitial lung diseases. Assessment involves more advanced imagi...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Socioeconomic determinants and disparities in sarcoidosis
Purpose of review The aim of this article is to describe the known health disparities that exist among patients with sarcoidosis by socioeconomic status, race, and gender, review potential contributors to health disparities in sarcoidosis, investigate the intersectionality among socioeconomic status, race, and gender in sarcoidosis, and outline a research agenda to address these disparities. Recent findings Recent studies have reported the significant financial strain a diagnosis of sarcoidosis has on individuals and the disproportionate affect the strain has on low socioeconomic status individuals, Blacks, and female...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research

Molecular profiling in sarcoidosis
Purpose of review Sarcoidosis is a systemic disease characterized by granulomatous inflammation of unknown cause. There is extensive heterogeneity between patients with respect to the number and types of organs involved, disease course, and response to therapy. Recent research in the field has leveraged ‘omics’ techniques such as transcriptomics to identify important ‘molecular profiles’ in the disease. These tools may help in identifying clinically useful biomarkers and targets for therapy. Recent findings Several studies have used gene expression profiling of predesignated lists or the entire genome to find ...
Source: Current Opinion in Pulmonary Medicine - August 13, 2020 Category: Respiratory Medicine Tags: SARCOIDOSIS: Edited by Daniel A. Culver and Hilario Nunes Source Type: research