Seminars in respiratory and critical care medicine最新文献

{"title":"Nocturnal Hypoxemia in Respiratory Medicine: Pathophysiology, Measurement, and Association with Outcomes.","authors":"Mohammadreza Hajipour, Gonzalo Labarca, Najib Ayas, Ali Azarbarzin","doi":"10.1055/a-2618-7422","DOIUrl":"10.1055/a-2618-7422","url":null,"abstract":"<p><p>Nocturnal hypoxemia is a prevalent feature of various respiratory diseases, significantly impacting patient outcomes and therapeutic strategies. Oximetry, a noninvasive and widely accessible tool, enables the measurement of nocturnal hypoxemia through oxyhemoglobin saturation (SpO₂)-derived metrics such as the oxygen desaturation index, percentage of sleep time with SpO₂ below 90%, mean SpO₂, and measures of the area under the desaturation curve (e.g., sleep apnea-specific hypoxic burden). While these metrics are well established in obstructive sleep apnea (OSA), their application in other respiratory conditions, including chronic obstructive pulmonary disease, pulmonary hypertension, obesity hypoventilation syndrome, heart failure, neuromuscular disorders, pregnancy, and high-altitude residents, remains an area of active investigation. This review explores the pathophysiology of hypoxemia in these conditions and evaluates the role of SpO₂-derived metrics in risk stratification beyond OSA. We also discuss the challenges of interpreting SpO₂ data, particularly the difficulty differentiating disease-related hypoxemia from comorbid OSA. Additionally, we examine the limitations of oximetry, including sensor inaccuracies, motion artifacts, and skin pigmentation. Finally, we emphasize the need for further research to standardize these metrics across diverse conditions and advocate for their integration into clinical practice to enhance patient management and outcomes.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbid Insomnia and Sleep Apnea: From Research to Clinical Practice.","authors":"Miguel Meira E Cruz, Alexander Sweetman","doi":"10.1055/a-2591-5664","DOIUrl":"10.1055/a-2591-5664","url":null,"abstract":"<p><p>Comorbid insomnia and sleep apnea (COMISA) represents a highly prevalent and clinically significant overlap between the two most common sleep disorders: insomnia and obstructive sleep apnea (OSA). COMISA is associated with greater impairment in sleep, daytime functioning, and physical and mental health compared with insomnia or OSA alone. Despite its prevalence, COMISA has historically been underrecognized, partially due to the conflicting symptoms of insomnia (e.g., hyperarousal and sleeplessness) and OSA (e.g., sleep fragmentation and excessive daytime sleepiness). Recent research highlights that COMISA is not merely the coexistence of insomnia and OSA but may involve unique pathophysiological interactions and clinical phenotypes. This review explores the epidemiology, mechanisms, and clinical manifestations of COMISA. We examine insomnia as a potential extension of OSA, where repeated apneic events lead to conditioned hyperarousal, as well as OSA as an extension of chronic insomnia through mechanisms such as autonomic dysregulation and respiratory instability. Furthermore, we consider COMISA as a distinct entity, characterized by bidirectional interactions between the two conditions that exacerbate their clinical and physiological burden. Key challenges in diagnosing COMISA are discussed, including overlapping symptoms and limitations in current assessment tools. Emerging evidence suggests that COMISA is associated with increased cardiovascular and metabolic risks, greater mental health burden, and reduced treatment adherence to positive airway pressure (PAP) therapy. Advances in tailored therapeutic approaches, including combined cognitive-behavioral therapy for insomnia and OSA management strategies, are highlighted as promising avenues to improve outcomes. Understanding COMISA as a multidimensional condition with diverse phenotypes and mechanisms underscores the need for integrated diagnostic frameworks and personalized treatment strategies to optimize patient care. Further research into its unique features and long-term consequences is critical to advancing clinical practice in sleep and respiratory medicine.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Course and Outcomes in Patients with Sjögren's Associated Interstitial Lung Disease.","authors":"Prachi Saluja, Joanna L Marco, Nitesh Gautam, Christine L Chhakchhuak, Gregory C Gardner, Nishant Gupta","doi":"10.1055/a-2578-4335","DOIUrl":"https://doi.org/10.1055/a-2578-4335","url":null,"abstract":"<p><p>Lung involvement in Sjögren's disease (SjD) is common and significantly impacts patients' quality of life, with the most frequent manifestation being interstitial lung disease (ILD). This study explored the clinical course and prognostic factors in patients with SjD-associated ILD.We conducted a retrospective analysis of patients diagnosed with SjD-ILD across two tertiary care academic referral centers. We assessed key clinical, radiological, and histopathological features of patients with SjD-ILD to investigate the long-term outcomes and determine the factors that can help better prognosticate patients in the clinic.A total of 81 patients with SjD-ILD were included in our analysis. ILD was the presenting manifestation in 21% (<i>n</i> = 17) of the SjD patients. The median survival following diagnosis of SjD-ILD was 11 years. Among ILD subtypes, the UIP pattern was associated with more rapid lung function decline and higher mortality. In contrast, higher baseline forced vital capacity (FVC) and anti-SSA antibody positivity were linked to reduced mortality risk.ILD is a common manifestation that can lead to the diagnosis of SjD. The presence of ILD has an adverse effect on the overall survival of patients with SjD. Baseline lung function and serologies can further assist in prognostication. A critical review of imaging patterns to determine the underlying ILD pattern can aid individualized counseling and therapeutic decision-making in patients with SjD-ILD.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotypes of Obesity Hypoventilation Syndrome: Characteristics and Outcomes.","authors":"Juan F Masa-Jiménez, Victor R Ramírez-Molina, Celia De Dios-Calama","doi":"10.1055/a-2591-5583","DOIUrl":"10.1055/a-2591-5583","url":null,"abstract":"<p><p>Obesity hypoventilation syndrome (OHS) is defined by the combination of obesity (body mass index [BMI] ≥30 kg/m²), sleep-disordered breathing, and daytime hypercapnia (arterial carbon dioxide tension [PaCO₂] ≥45 mm Hg at sea level) during wakefulness occurring in the absence of an alternative neuromuscular, mechanical, or metabolic explanation for hypoventilation. Patients with OHS can be classified by phenotypes depending on whether or not they have obstructive respiratory events: hypoventilation and no or not significant obstructive sleep apnea (OSA) and hypoventilation and significant OSA; we also add a third phenotype, which is the hospitalized patient with acute-on-chronic respiratory failure. We describe the mid- and long-term outcomes with and without positive airway pressure (PAP) by these three phenotypes.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision Medicine to Guide Obstructive Sleep Apnea Treatment Beyond the Continuous Positive Airway Pressure.","authors":"Gonzalo Labarca, Mario Henríquez-Beltrán, Daniel Solomons","doi":"10.1055/a-2591-5502","DOIUrl":"https://doi.org/10.1055/a-2591-5502","url":null,"abstract":"<p><p>Obstructive sleep apnea (OSA) is a widespread condition associated with an elevated risk of adverse outcomes. Continuous positive airway pressure (CPAP) is the gold standard treatment, particularly for moderate to severe OSA. However, in many instances, CPAP compliance falls short of expectations, necessitating physicians to consider additional interventions to alleviate patient symptoms. A comprehensive understanding of OSA endotypes and phenotypes can potentially enhance the confidence in selecting the appropriate combination or intervention to improve patient care. In this review, we will discuss various interventions and medications available to enhance the treatment of patients with OSA, following a precision medicine approach.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life After COVID-19: Alterations Related to Sleep and Circadian Rhythms.","authors":"Adriano D S Targa, Mario Henríquez-Beltrán, Anna Galan-Gonzalez, Ferran Barbé","doi":"10.1055/a-2591-5627","DOIUrl":"https://doi.org/10.1055/a-2591-5627","url":null,"abstract":"<p><p>World Health Organization (WHO) estimates reveal that over 777 million people were reportedly infected by SARS-CoV-2, with approximately 7 million deaths and 770 million surviving the disease up to April 2025. Beyond the immediate social and economic impact, an additional challenge arises as a large percentage of COVID-19 survivors report a wide range of symptoms after the acute phase, including fatigue, shortness of breath, cognitive difficulties, joint and muscle pain, chest pain, heart palpitations, loss of taste or smell, headaches, depression, anxiety, and sleep and circadian alterations. In this chapter, we will specifically address the sleep- and circadian rhythm-related alterations within this context. First, we will focus on sleep-related changes following the acute phase of the disease, detailing their manifestations, prevalence, and associated factors. We will then discuss the potential impact of these sleep-related aspects on the risk of SARS-CoV-2 infection, the severity of COVID-19, and the presence of post-COVID-19 conditions. A similar approach will be applied to address the circadian-related alterations. Finally, we will provide a comprehensive discussion on the overall limitations of available knowledge and its applicability, highlighting the relevance of these findings for the present and future.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep and Cardiovascular Health.","authors":"Lucía Pinilla, Irene Cano-Pumarega, Manuel Sánchez-de-la-Torre","doi":"10.1055/a-2591-5462","DOIUrl":"https://doi.org/10.1055/a-2591-5462","url":null,"abstract":"<p><p>Sleep is recognized as a foundational pillar of health, essential for maintaining nearly all vital processes, and a crucial component of cardiovascular function. In recent years, there has been a paradigm shift to conceptualize sleep health as a combination of multiple domains, including duration, timing, quality, variability/regularity, habits/behaviors, and disordered sleep. This review provides a comprehensive overview of the current evidence linking the multifaceted elements that contribute to healthy sleep with cardiovascular and blood pressure-related outcomes. The reviewed literature indicates a strong relationship between sleep and cardiovascular health. However, the specific pathophysiological mechanisms that bridge the various dimensions of sleep with cardiovascular outcomes remain elusive. Given the global burden of cardiovascular disease, understanding the interplay between sleep and cardiovascular health has important implications for both individual and population health. Sustained efforts to move beyond a focus on discrete domains of sleep are essential to fully understand this complex and potentially bidirectional relationship. Promoting healthy sleep patterns and optimizing the management and treatment of sleep disorders are key steps toward developing more comprehensive strategies for reducing cardiovascular risk. Integrating sleep health into routine clinical care is identified as a critical opportunity to enhance cardiovascular disease prevention and management, particularly among vulnerable and high-risk populations.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructive Sleep Apnea and Chronic Obstructive Pulmonary Disease Overlap Syndrome.","authors":"Marta Marin-Oto, David Sanz-Rubio, José M Marin","doi":"10.1055/a-2531-1166","DOIUrl":"https://doi.org/10.1055/a-2531-1166","url":null,"abstract":"<p><p>The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in the same patients is defined as COPD/OSA overlap syndrome (OVL). OSA and sleep complaints are quite common among COPD patients and contribute to an increase in the risk of COPD exacerbation and mortality. Patients with OVL are more likely to develop cardiometabolic disease than patients with OSA or COPD alone. We must consider OSA as a treatable trait since the use of positive pressure ventilation reduces severe exacerbations, all-cause hospitalizations, and mortality in patients with COPD.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep, Circadian Rhythms, and Lung Cancer.","authors":"Daniel H Cooper, Isaac Almendros, Tetyana Kendzerska","doi":"10.1055/a-2531-1059","DOIUrl":"10.1055/a-2531-1059","url":null,"abstract":"<p><p>Lung cancer is the leading cause of cancer-related mortality worldwide, with the prevalence of the disease continually rising. Therefore, identifying disease-modifying risk factors is critical, with increasing recognition of the impact of sleep quality/sleep disorders. This narrative review summarizes the evidence on the role of five domains of sleep on lung cancer incidence and progression: (i) sleep quality/duration, (ii) sleep disordered breathing, (iii) circadian rhythm disturbances, (iv) sleep-related movement disorders, and (v) personal, environmental, and social factors that modulate each of these associations. Epidemiological evidence supports reduced sleep duration, increased sleep duration, poor sleep quality, insomnia, obstructive sleep apnea, evening chronotype, peripheral limb movements in sleep, and less robustly for night shift work and restless leg syndrome to be associated with increased risk of lung cancer development, with potential impacts on cancer survival outcomes. Proposed mechanisms underlying the biological plausibility of these epidemiological associations are also explored, with common theories relating to immune dysregulation, metabolic alterations, reductions in melatonin, sympathetic overactivation, increased reactive oxygen species, production of protumorigenic exosomes, and inflammation. We also summarized potential treatments addressing impaired sleep quality/sleep disorders and their ability to attenuate the risk of lung cancer and improve cancer survival. Although evidence on reversibility is inconsistent, there are trends toward positive outcomes. Future research should focus on clinical trials to confirm cause and effect relationships, large epidemiologic studies for incidence/prognosis, clarification on the relative efficacy of treatment modalities, and more in vivo animal models to establish the molecular mechanisms underlying these relationships.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Neuromuscular Disease in Adults Presenting with Dyspnea.","authors":"Daniel Scullin, Joseph Barney","doi":"10.1055/a-2535-0859","DOIUrl":"https://doi.org/10.1055/a-2535-0859","url":null,"abstract":"<p><p>Neuromuscular disorders in adults can present with a wide array of clinical features and vary from acute life-threatening complications such as respiratory failure to slow progressive weakness and comorbidity. Common to most of these disorders are symptoms of weakness and dyspnea. Many patients with occult neuromuscular disorders will be evaluated for underlying cardiac and pulmonary disease by primary care and subspecialty providers and can experience delays in diagnosis due to challenges in attaining early neurological testing and recognizing vague symptoms as potentially arising from the neuromuscular apparatus. Additionally, many adults who develop neuromuscular disorders have concomitant cardiac or pulmonary disease and the presence of dyspnea or limitations in mobility are often attributed to these without pursuing further workup. We outline a review of neuromuscular diseases in adults and an approach to evaluation.</p>","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}