Using a simple decisional flowchart we were able to remove tracheotomy cannula in almost 80% of the patients with spontaneous breathing autonomy without major clinical complications. Further larger prospective studies are needed to confirm this clinical approach in larger and different populations.

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INTRODUCTIONOBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS) IS CHARACTERIZED BY REPETITIVE, COMPLETE, OR PARTIAL UPPER-AIRWAY OCCLUSION that causes a reduction or cessation of breathing associated with blood oxygen desaturation and sleep fragmentation. Both recurrent hypoxic episodes and arousals-related, end-apneic hyperadrenergic reactions may be responsible for OSAassociated complications.Erectile dysfunction (ED) and other sexual problems are common among men with sleep apnea. Guilleminault et al. reported a 28% prevalence rate of sexual problems among men with OSAS, 1 Watson et al. reported a loss of interest in sex that was correlated with the number of obstructive sleep apneas and the lowest oxygen saturation in patients with sleep apnea. 2 A high prevalence of sleep apnea among men with ED has also been observed: the prevalence of OSAS in men with ED has been reported to range from 30% to 50% of patients. 3,4 OSAS is often associate with medical conditions including diabetes mellitus and hypertension that are known to cause ED per se. In addition, erectile problems, which are reported in up to 20% of untreated hypertensive men, may worsen with the use of some anti-hypertensive medications. 5 Nevertheless, no conclusive hypotheses or evidence about the mechanism responsible for the development of ED in OSAS patients have yet been published in the literature-although both vascular or endocrine alterations has been considered as a cause of ED. 6,7 So far, ED in OSAS patients has been investigated by clinical evaluation and/or questionnaires or by measuring nocturnal penile tumescence evaluation (NPT), which is able to define erectile function. Neurophysiological assessment of sacral spinal cord segment, on the other hand, provides objective data on the functioning of the sacral reflex arc, thus supplying a quantitative approach to different somatic and vegetative pathways involved in the control of erection. Indeed the international guidelines now suggest performing neurophysiological tests in the diagnosis of ED. 8 Recently, Mayer et al. demonstrated that OSAS patients may developed peripheral nerve dysfunction, the severity Abstract: Erectile dysfunction (ED) is common in men with obstructive sleep apnea (OSAS) but no completely convincing hypotheses about the underlying pathogenic mechanisms have been published in the literature. The aims of the present study were to assess the presence of ED in a group of OSAS patients without daytime respiratory failure and to determine whether this dysfunction was related to peripheral nerve involvement. Evaluation of the bulbocavernosus reflex (BCR) and the somato-sensory evoked potentials of pudendal nerve (PSEPs), the most widely established method of documenting pudendal neuropathies as being the cause of impotence, was performed in 25 patients. Data on BCR were compared with those of 25 healthy males volunteers matched for age. BCR was altered in 17 patients: in 6 it was elicited while in 11 it had a prolonged latency and reduced amplitude. Patients with altered BCR pr...

B Br re ea at th hi in ng g p pa at tt te er rn n, , v ve en nt ti il la at to or ry y d dr ri iv ve e a an nd d r re es sp pi ir ra at to or ry y m mu us sc cl le e s st tr re en ng gt th h i in n p pa at ti ie en nt ts s w wi it th h c ch hr ro on ni ic c h he ea ar rt t f fa ai il lu ur re e N. Ambrosino*, C. Opasich**, P. Crotti*, F. Cobelli**, L. Tavazzi**, C. Rampulla* CHF patients showed a slight reduction in lung volumes and in diffusion capacity. In CHF neural drive, as assessed by mouth occlusion pressure (P 0.1 ), was significantly increased in comparison to controls (P 0.1 = 1.86 (0.7) and 1.4 (0.6) cmH 2 O in CHF and controls respectively). Analysis of breathing pattern showed only a slight yet significant increase in respiratory frequency while respiratory muscle strength, as assessed by measurement of maximal inspiratory and expiratory pressures (MIP and MEP respectively) was slightly reduced (MIP=79(27) and 104(28); MEP=111(32) and 142(33) cmH 2 O respectively). Observed changes were more relevant in patients with advanced NYHA functional classes whereas no relationship among indices of cardiac and respiratory function was found.We conclude that chronic heart failure induces changes in neural ventilatory drive and respiratory muscle strength related to the severity of the disease.