Exhaled pH, exhaled nitric oxide, and induced sputum cellularity in obese patients with obstructive sleep apnea syndrome. Transl Res

Institute of Respiratory Disease, Department of Medical and Occupational Sciences, University of Foggia, Foggia, Italy.
Translational Research (Impact Factor: 5.03). 02/2008; 151(1):45-50. DOI: 10.1016/j.trsl.2007.09.004
Source: PubMed


Airway inflammation plays an important role in obstructive sleep apnea syndrome as well as in obesity. Increasingly, researchers are studying airway inflammation noninvasively and are studying the new markers of airways inflammation. The aim of this study was to measure pH in the exhaled breath condensate (EBC), the exhaled nitric oxide (NO), and the inflammatory cell profile in the induced sputum of obese patients with and without obstructive sleep apnea syndrome (OSAS). The pH in EBC, the exhaled NO, and the induced sputum cells were measured in 30 obese patients with OSAS (OOs), in 20 obese patients without OSAS (ONOs), and in 10 healthy patients (HPs). Levels of pH in EBC were lower in OOs and in ONOs than in HPs. Furthermore, the concentrations of exhaled NO and the percentages of neutrophils in the induced sputum were greater in OOs and in ONOs than in HPs. No significant differences were found between OO and ONO for other measurements of airway inflammation. This study shows the presence of airway's inflammation in obese patients with and without OSAS and indicates that the "exhaled acidopnea" as well as exhaled NO and sputum neutrophils are good tools to measure airway inflammation in these subjects.

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Available from: Giovanna elisiana Carpagnano, Oct 16, 2014
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    • "j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / y n i o x unchanged [9] or increased [10] [11] [12] [13] [14] [15] [16] [17] in patients with OSA. FENO is however a poor marker of NO production in the distal parts of the lungs, i.e. small airways and alveolar spaces. "
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    ABSTRACT: To assess distal/alveolar inflammation in patients with suggestive symptoms of obstructive sleep apnoea (OSA) using exhaled nitric oxide (NO) measured by two-compartment model (2-CM) after correction for axial NO back-diffusion (trumpet model). Ninety five patients suspected for OSA prospectively underwent pulmonary function test, overnight polysomnography (PSG), and exhaled NO measurement. Patients with apnoea-hypopnoea index (AHI) <5/hour were included in non-OSA group. Exhaled NO was repeatedly measured after PSG in 21 OSA patients and 8 non-OSA subjects. Alveolar NO concentration (CANO) was significantly higher in OSA patients (n=71; 4.07±1.7ppb) as compared with non-OSA subjects (n=24; 2.24±1.06ppb; p<0.0001) whilst maximal bronchial NO flux (J'awNO) and fractional exhaled NO (FENO) did not differ between the two groups. CANO was strongly associated to AHI (r=0.701; p<0.0001) and to recording time with SaO2<90% (ST-90%; r=0.659; p<0.0001) in OSA patients but not in non-OSA persons. The area under ROC curve for screening patients with OSA and significant nocturnal oxygen desaturation (ST-90%>1%) was 0.865±0.036 (95% IC, 0.793-0.937; p<0.0001). CANO at 4.5 ppb could detect these patients with specificity of 94% and sensitivity of 46%. Increase of CANO measured after PSG was significantly related to oxygen desaturation index (ST-90%) in OSA patients. Increased alveolar NO concentration was related to the severity of nocturnal oxygen desaturation in patients with OSA, linking the distal airway inflammation to intermittent hypoxia. (250 words). Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Jan 2015 · Nitric Oxide
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    • "The atopy status, expressed as the prevalence of positive SPT reactions to common inhalatory allergens, was similar in both sawmills and close to the prevalence found in a population-based study in adult male Croatian subjects (27 %) (Macan et al. 2007). The lack of correlation with BMI could be explained by low number of obese subjects in the present study (five workers), namely the influence of nutritional status on EBC pH in the published literature, in terms of EBC acidification, was found for obese subjects (Carpagnano et al. 2008; Do et al. 2008b). Lower EBC pH values in current smokers compared to non-smoking subjects have been repeatedly described (Do et al. 2008b; Koczulla et al. 2010; Ljubičic´Cálušicét al. 2011; MacNee et al. 2011), and it has been found that cumulative smoking dose is inversely correlated with EBC pH (Do et al. 2008b). "
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    ABSTRACT: Purpose The aim of the study was to evaluate exhaled breath condensate acidity (EBC pH) as a biomarker of airway response to occupational respiratory hazards present in sawmill. Methods Sixty-one sawmill workers in total (26 from Sawmill 1 and 35 from Sawmill 2) provided EBC samples at the beginning and at the end of the working week. Respiratory symptoms, lung function, bronchodilator test and atopy status were assessed. Occupational environment was checked for the levels of respiratory hazards. Results Airborne dust concentrations were below threshold limit value. Endotoxin in Sawmill 1 and Sawmill 2, and moulds in Sawmill 1 were at the levels able to induce inflammatory response in the airways. Mould levels were 2.5 times higher in Sawmill 1 than in Sawmill 2. Compared to Sawmill 2 workers, lower spirometry values, higher prevalence of dry cough and positive bronchodilator test were found in Sawmill 1 workers. Monday EBC pH values did not differ between sawmills, but declined after one working week in Sawmill 1 workers (from 7.88 to 7.49, P = 0.012) and not in Sawmill 2 workers. Similar results were obtained when only respiratory healthy non-smokers were analysed. Monday-to-Friday change of other respiratory parameters was not observed. Conclusion The results suggest EBC pH as a biomarker of acute respiratory effects related to occupational exposure to respiratory hazards in sawmills, presumably increased mould levels. The effect was present even at subclinical level, namely in respiratory healthy subjects. The long-term health implications remain unclear and should be evaluated in a follow-up study.
    Full-text · Article · Sep 2012 · International Archives of Occupational and Environmental Health
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    • "In a study performed in Sweden, the number of patients with chronic bronchitic symptoms that were found to have sleep-disordered breathing was up to 14-29% [19]. Other studies on patients with OSA have shown an increase in exhaled nitric oxide values and other markers of inflammation on sputum analyses [20,21]. A number of OSA patients can present with bronchitic symptoms and demonstrate bronchial hyperreactivity [22,23]. "
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    ABSTRACT: Recent reports suggest an association between unexplained chronic cough and obstructive sleep apnea (OSA). Current guidelines provide an empiric integrative approach to the management of chronic cough, particularly for etiologies of gastroesophageal reflux (GERD), upper airway cough syndrome (UACS) and cough variant asthma (CVA) but do not provide any recommendations regarding testing for OSA. This study was done to evaluate the prevalence of OSA in patients referred for chronic cough and examine the impact of treating OSA in resolution of chronic cough. A retrospective review of chronic cough patients seen over a four-year period in a community-based pulmonary practice was done. Patients with abnormal chest radiographs, abnormal pulmonary function tests, history of known parenchymal lung disease, and inadequate followup were excluded. Clinical data, treatments provided and degree of resolution of cough was evaluated based on chart review. Specifically, diagnostic testing for OSA and impact of management of OSA on chronic cough was assessed. 75 patients with isolated chronic cough were identified. 44/75 had single etiologies for cough (GERD 37%, UACS 12%, CVA 8%). 31/75 had multiple etiologies for their chronic cough (GERD-UACS 31%, GERD-CVA 5%, UACS-CVA 3%, GERD-UACS-CVA 3%). 31% patients underwent further diagnostic testing to evaluate for UACS, GERD and CVA. Specific testing for OSA was carried out in 38/75 (51%) patients and 33/75 (44%) were found to have obstructive sleep apnea. 93% of the patients that had interventions to optimize their sleep-disordered breathing had improvement in their cough. OSA is a common finding in patients with chronic cough, even when another cause of cough has been identified. CPAP therapy in combination with other specific therapy for cough leads to a reduction in cough severity. Sleep apnea evaluation and therapy needs to considered early during the management of chronic cough and as a part of the diagnostic workup for chronic cough.
    Full-text · Article · Apr 2010 · Cough
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