Obstructive sleep apnea (OSA) is a highly prevalent disease, and is traditionally associated with increased cardiovascular risk. The role of comorbidities in OSA patients has emerged recently, and new conditions significantly associated with OSA are increasingly reported. A high comorbidity burden worsens prognosis, but some data suggest that CPAP might be protective especially in patients with comorbidities. Aim of this narrative review is to provide an update on recent studies, with special attention to cardiovascular and cerebrovascular comorbidities, the metabolic syndrome and type 2 diabetes, asthma, COPD and cancer. Better phenotypic characterization of OSA patients, including comorbidities, will help to provide better individualized care. The unsatisfactory adherence to CPAP in patients without daytime sleepiness should prompt clinicians to examine the overall risk profile of each patient in order to identify subjects at high risk for worse prognosis and provide the optimal treatment not only for OSA, but also for comorbidities.

SUMMARYObstructive sleep apnea often coexists with visceral adiposity and metabolic syndrome. In this study, we analysed gender-related differences in anthropometrics according to sleep apnea severity and metabolic abnormalities. In addition, the visceral adiposity index, a recently introduced marker of cardiometabolic risk, was analysed. Consecutive subjects with suspected obstructive sleep apnea (n = 528, 423 males, mean age AE standard deviation: 51.3 AE 12.8 years, body mass index: 31.0 AE 6.2 kg m À2 ) were studied by full polysomnography (apneahypopnea index 43.4 AE 27.6 h À1 ). Variables of general and visceral adiposity were measured (body mass index, neck, waist and hip circumferences, waist-to-hip ratio). The visceral adiposity index was calculated, and metabolic syndrome was assessed (NCEP-ATP III criteria). The sample included controls (apnea-hypopnea index <10 h À1 , n = 55), and patients with mild-moderate (apnea-hypopnea index 10-30 h À1, n = 144) and severe sleep apnea (apnea-hypopnea index >30 h À1 , n = 329). When anthropometric variables were entered in stepwise multiple regression, body mass index, waist circumference and diagnosis of metabolic syndrome were associated with the apneahypopnea index in men (adjusted R 2 = 0.308); by contrast, only hip circumference and height-normalized neck circumference were associated with sleep apnea severity in women (adjusted R 2 = 0.339). These results changed little in patients without metabolic syndrome; conversely, waist circumference was the only correlate of apnea-hypopnea index in men and women with metabolic syndrome. The visceral adiposity index increased with insulin resistance, but did not predict sleep apnea severity. These data suggest gender-related interactions between obstructive sleep apnea, obesity and metabolic abnormalities. The visceral adiposity index was a good marker of metabolic syndrome, but not of obstructive sleep apnea. IN TROD UCTI ONObesity is a major risk factor for obstructive sleep apnea (OSA), and OSA is more prevalent among obese than nonobese patients. The first studies, mostly conducted in men, identified body mass index (BMI), and neck and waist circumference as major predictors of OSA. Women with OSA were usually older and more obese than men, but had smaller neck circumference and less centrally distributed fat (Kapsimalis and Kryger, 2002a,b). Adiposity and sleepMore recent literature re-examined anthropometrics in patients with OSA by assessing gender-related differences in adipose tissue distribution, suggesting the need to take into account the new information in order to develop new models possibly indicative of gender-specific OSA phenotypes. Some studies highlighted the close relationship of OSA severity with neck circumference normalized by height (NC/h) and visceral fat in both genders (Kawaguchi et al., 2011;Simpson et al., 2010). Conversely, a recent study found that visceral abdominal fat was increased in men but not in women with OSA; women with OSA showed increased total and subcutaneous fat with a n...

Educational aimsTo illustrate the characteristics of endurance exercise training and its positive effects on health.To provide an overview on the effects of endurance training on airway cells and bronchial reactivity.To summarise the current knowledge on respiratory health problems in elite athletes.Endurance exercise training exerts many positive effects on health, including improved metabol­ism, reduction of cardiovascular risk, and reduced all-cause and cardiovascular mortality. Intense endurance exercise causes mild epithelial injury and inflammation in the airways, but does not appear to exert detrimental effects on respiratory health or bronchial reactivity in recreational/non-elite athletes. Conversely, elite athletes of both summer and winter sports show increased susceptibility to development of asthma, possibly related to environmental exposures to allergens or poor conditioning of inspired air, so that a distinct phenotype of “sports asthma” has been proposed to characterise such athletes, who more often practise aquatic and winter sports. Overall, endurance training is good for health but may become deleterious when performed at high intensity or volume.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or COVID-19 disease) was declared a pandemic on 11th March 2020 by the World Health Organization. This unprecedented circumstance has challenged hospitals’ response capacity, requiring significant structural and organizational changes to cope with the surge in healthcare demand and to minimize in-hospital risk of transmission. As our knowledge advances, we now understand that COVID-19 is a multi-systemic disease rather than a mere respiratory tract infection, therefore requiring holistic care and expertise from various medical specialties. In fact, the clinical spectrum of presentation ranges from respiratory complaints to gastrointestinal, cardiac or neurological symptoms. In addition, COVID-19 pandemic has created a global burden of mental illness that affects the general population as well as healthcare practitioners. The aim of this manuscript is to provide a comprehensive and multidisciplinary insight into the complexity of this disease, reviewing current scientific evidence on COVID-19 management and treatment across several medical specialties involved in the in-hospital care of these patients.

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