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Introduction: Little information exists in the general population whether clinical presentation phenotypes of obstructive sleep apnea (OSA) differ in terms of sleep quality and comorbidities.Aim: The purpose of our study was to assess possible differences between symptomatic and asymptomatic OSA patients concerning syndrome's severity, patients' sleep quality, and comorbidities.Subjects and methods: First, in a nationwide, stratified, epidemiological survey, 4,118 Cypriot adult participants were interviewed about sleep habits and complaints. In the second stage of the survey, 264 randomly selected adults underwent a type III sleep study for possible OSA. Additionally, they completed the Greek version of Pittsburgh Sleep Quality Index (Gr-PSQI), Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), and Hospital Anxiety and Depression Scale (HADS).Results: From 264 enrolled participants, 155 individuals (40 females and 115 males) were first diagnosed with OSA. Among these 155 patients, 34% had ESS ≥ 10 and 49% AIS ≥ 6. One or both symptoms present categorized the individual as symptomatic (60%) and neither major symptom as asymptomatic (40%). There were no significant statistical differences (SSDs) between the two groups (symptomatic–asymptomatic) with regard to anthropometrics [age or gender; neck, abdomen, and hip circumferences; and body mass index (BMI)]. The two groups had no differences in OSA severity—as expressed by apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and mean oxyhemoglobin saturation (SaO2)—and in cardiometabolic comorbidities. Symptomatic patients expressed anxiety and depression more often than asymptomatics (p < 0.001) and had poorer subjective sleep quality (Gr-PSQI, p < 0.001). According to PSQI questionnaire, there were no SSDs regarding hours in bed and the use of sleep medications, but there were significant differences in the subjective perception of sleep quality (p < 0.001), sleep efficiency (p < 0.001), duration of sleep (p = 0.001), sleep latency (p = 0.007), daytime dysfunction (p < 0.001), and finally sleep disturbances (p < 0.001).Conclusion: According to our data, OSA patients reporting insomnia-like symptoms and/or sleepiness do not represent a more severe phenotype, by the classic definition of OSA, but their subjective sleep quality is compromised, causing a vicious cycle of anxiety or depression.

Obstructive sleep apnea (OSA) is a chronic and prevalent disorder, strongly associated with cardiovascular disease (CVD). The apnea-hypopnea index (AHI), or respiratory event index (REI), and the oxygen desaturation index (ODI) are the clinical metrics of sleep apnea in terms of diagnosis and severity. However, AHI, or REI, does not quantify OSA-related hypoxemia and poorly predicts the consequences of sleep apnea in cardiometabolic diseases. Moreover, it is unclear whether ODI correlates with CVD in OSA. Our study aimed to examine the possible associations between respiratory sleep indices and CVD in OSA, in a non-clinic-based population in Cyprus. We screened 344 subjects of a stratified, total sample of 4118 eligible responders. All participants were adults (age 18+), residing in Cyprus. Each patient answered with a detailed clinical history in terms of CVD. A type III sleep test was performed on 282 subjects (81.97%). OSA (REI ≥ 15) was diagnosed in 92 patients (32.62%, Group A). REI < 15 was observed in the remaining 190 subjects (67.37%, Group B). In OSA group A, 40 individuals (43%) reported hypertension, 17 (18.5%) arrhythmias, 10 (11%) heart failure, 9 (9.8%) ischemic heart disease and 2 (2%) previous stroke, versus 46 (24%), 21 (11%), 7 (3.7%), 12 (6.3%) and 6 (3%), in Group B, respectively. Hypertension correlated with REI (p = 0.001), ODI (p = 0.003) and mean SaO2 (p < 0.001). Arrhythmias correlated with mean SaO2 (p = 0.001) and time spent under 90% oxygen saturation (p = 0.040). Heart failure correlated with REI (p = 0.043), especially in the supine position (0.036). No statistically significant correlations were observed between ischemic heart disease or stroke and REI, ODI and mean SaO2. The pathogenesis underlying CVD in OSA is variable. According to our data, hypertension correlated with REI, ODI and mean SaO2. Arrhythmias correlated only with hypoxemia (mean SaO2), whereas heart failure correlated only with REI, especially in the supine position.

C hronic obstructive pulmonary disease (COPD) is characterized by dyspnea, fatigue, exercise intolerance, poor quality of life, and high rates of morbidity and mortality. 1 In addition, peripheral muscle weakness 2 and inability to perform activities of daily living (ADL) with the upper limbs (UL) are common findings among patients with COPD. 3 Pulmonary rehabilitation (PR) programs are offered worldwide for the management of COPD and exercise training is a core component of PR. 4 Evidence suggests that exercise training can improve muscle function in patients with COPD, 2,5 and can drive improvements of oxidative 6 and exercise capacity, 4,5,7 and reduce ventilatory requirements and dyspnea. 8 Although similar beneficial effects have also been reported in patients with COPD for resistance and endurance training, 9 the specifics and the relative contribution of the upper limb exercise training (ULET) in PR of these patients remain unclear. 5 Findings from previous systematic reviews evaluating ULET in patients with COPD were inconsistent with respect to the translation of UL functional improvements reported to outcome measures such as health-related quality of life (HRQL), dyspnea, and ADL. [10][11][12][13] Recent evidence from a systematic review and meta-analysis indicates no effect in dyspnea and HRQL when endurance ULET was compared with resistance ULET, or when ULET combined with lower limb exercise training was compared with lower limb training alone. 3 Recent PR guidelines included endurance and resistance exercise for developing cardiorespiratory function, musculoskeletal fitness, and HRQL. 5,14 Upper limb exercise training has also been recommended given the evidence for improvements in UL function 5 ; however, the effectiveness of ULET in ADL of patients with COPD, as well as the optimal type of ULET, has yet to be determined due to the limited evidence comparing the effectiveness of different UL training interventions. 3 Given the lack of evidence from studies combining endurance and resistance ULET on patient-relevant outcomes, the main objective of the present study was to evaluate the effects of a rehabilitation program including resistance ULET with and without the addition of endurance ULET on ADL, HRQL, peripheral muscle strength, dyspnea, and fatigue perception in patients with COPD. METHODSPatients with stable COPD were referred for a PR program at Nicosia General Hospital. Consecutive patients were approached over a period of 18 mo (December 2017 to June 2019). Patients were included if they had: (1) diagnosis of