Stefan Mihaicuta

Victor Babes University of Medicine and Pharmacy of Timisoara | UMFT · Pulmonology, Victor Babes Hospital

Background: Severe asthma often remains uncontrolled despite optimized inhaled treatment. The rise of biologic therapy in severe asthma represented a major advance for the disease management. However, correct phenotyping and monitoring of severe asthma patients is key to the success of targeted biologic therapy. Materials and Methods: We present th...

Background and Objectives: Severe adult-onset eosinophilic asthma and COPD with eosinophilic inflammation are two entities with a similar clinical course and are sometimes difficult to differentiate in clinical practice, especially in patients with a history of smoking. Anti-IL-5 or -IL-5R biological therapy has been shown to be highly effective in...

Background: Despite advancements in coronary artery bypass grafting (CABG), the optimal choice of graft material remains a subject of investigation. This study aimed to comprehensively analyze the morphological characteristics of varicose veins, exploring their potential utilization in CABG compared to healthy veins. Methods: The study included...

Background: Work-related asthma has become a highly prevalent occupational lung disorder. Objective: Our study aims to evaluate occupational exposure as a predictor for asthma exacerbation. Method: We performed a retrospective evaluation of 584 consecutive patients diagnosed and treated for asthma between October 2017 and December 2019 in four...

Obstructive sleep apnea increases morbidity and mortality risks. The most common treatment is continuous positive airway pressure, with nasal mask usage being important, but not always optimal. While most research on treatment adherence focuses on the patient, the bed partner's involvement may be detrimental. Our study aim is to obtain a European‐w...

Aims We analysed longitudinal blood pressure (BP) data from hypertensive obstructive sleep apnoea (OSA) patients in the European Sleep Apnea Database cohort. The study investigated the interaction between positive airway pressure (PAP)-induced BP change and antihypertensive treatment (AHT). Methods and results Hypertensive patients with AHT [monot...

Introduction: In response to injury, epithelial cells release alarmins including thymic stromal lymphopoietin (TSLP), high mobility group-box-1 (HMGB1), interleukin (IL)-33 and -25 that can initiate innate immune responses. These alarmins are recognized as activators of T2-immune responses characteristic for asthma, but recent evidence highlighted...

Periodic limb movements during sleep and obstructive sleep apnea are both associated with increased sympathetic tone, and have been proposed as risk factors for heart diseases and, in particular, cardiovascular disease. As sympathetic system activation may lead to dyslipidaemia, periodic limb movements during sleep could be an additional risk facto...

Introduction Combinations of protease inhibitors such as lopinavir and darunavir with ritonavir have been repurposed as treatments for COVID-19. Lopinavir-ritonavir (LPV/r) and darunavir-ritonavir (DRV/r) showed in vitro efficacy against COVID-19, but the results are conflicting for human studies. Thus, our aim was to compare the efficacy of LPV/r...

The aftermath of severe COVID-19 frequently involves considerable cardiopulmonary damage, necessitating rehabilitation. This study aimed to evaluate the impact of COVID-19 on cardiopulmonary health and assess the effectiveness of various rehabilitative interventions. Conducted between September 2021 and September 2022, this prospective study includ...

Introduction We analyse anthropometric, somnopolygraphic and comorbidities data in patients with OSA syndrome, OSA with COPD, and OSA with COPD and obesity. Material and method 2644 OSA patients, three groups: I – OSA (2112 pts., 79.9%); II – OSA and COPD (116 pts., 4.4%); III – OSA, COPD and obesity (416 pts., 15.7%). Results significantly older...

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) syndrome (OSAS) are both common conditions. Their comorbid association – overlap syndrome (OVS) – can result in clinically important nocturnal oxygen desaturation. We sought to compare demographic and anthropometric characteristics, associated comorbidities and oxygen s...

Background: Nocturnal hypoxaemia measured as the percentage of total sleep time spent with saturation below 90% (TST90%) may better predict cardiovascular consequences of obstructive sleep apnoea (OSA) than the number of obstructive respiratory events measured with the apnoea-hypopnea index (AHI). Deeper hypoxaemia may potentially induce more seve...

Background: Currently there are no universally accepted criteria to measure the response to biologics available as treatment for severe asthma. This survey aims to establish consensus criteria to use for the evaluation of response to biologics after four months of treatment. Method: Using Delphi methodology, a questionnaire including ten items w...

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Current COPD diagnosis (i.e., spirometry) could be unreliable because the test depends on an adequate effort from the tester and testee. Moreover, the early diagnosis of COPD is challenging. We address COPD detection by constructing two novel physiological...

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide. Current COPD diagnosis (i.e., spirometry) could be unreliable because the test depends on an adequate effort from the tester and testee. Moreover, the early diagnosis of COPD is challenging. We address COPD detection by constructing two novel physiological...

Background Nocturnal hypoxaemia measured by the percentage of total sleep time spent with saturation below 90% (TST90%) may better predict cardiovascular consequences of obstructive sleep apnoea (OSA) than the number of obstructive respiratory events measured with the apnoea-hypopnea index (AHI). Deeper hypoxaemia may potentially induce more severe...

Background The prevalence of obstructive sleep apnoea (OSA) is growing as the population is ageing. However, data on the clinical characteristics of elderly OSA patients and their adherence to positive airway pressure (PAP) treatment are scarce. Methods Data of 23,418 30–79-year-old OSA patients prospectively collected into the ESADA database duri...

Objective Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3⁻]) and nocturnal hypoxia as well as comorbid hypertension in OSA. Methods A cross-sectional analysis of 3329 patients in the Europea...

Background : Several biologics are now available as add-on treatment for severe asthma but, currently there are no universally accepted criteria to measure the response to these therapies. This survey aims to establish consensus criteria to use in practice for the initial evaluation of response to biologics after four months of treatment. Method: U...

Objectives-Aim Assesment of echocardiographic parameters in patients with coexisting obstructive sleep apnea (OSA) and heart failure (HF) Methods ▪ 143 OSA and HF patients were included. ▪Data collection: socio-demographic data, NC, AC, sleep questionnaires, comorbidities, blood test data, polygraphy and echocardiographic data (TDV-telediastolic vo...

Introduction : The European Sleep Apnea Database (ESADA) was used to identify distinguishable obstructive sleep apnea (OSA) phenotypes and to investigate the clinical outcome during positive airway pressure (PAP) treatment. Method : Prospective OSA patient data were recruited from 35 sleep clinics in 21 European countries. Unsupervised cluster ana...

Sudden death (SD) in athletes is a potential avoidable dramatic scenario. When done regularly, cardiological evaluation increases the chances of diagnosing ventricular pre-excitation. Consequently, the following question arises: what is the real incidence of SD risk in athletes with Wolff-Parkinson-White (WPW) syndrome/pattern? This study included...

Purpose: Obstructive sleep apnoea (OSA) is a recognised risk factor for cardiovascular disease. However, it is difficult to evaluate the risk of cardiovascular disease in patients with OSA due to multiple shared risk factors. Composite lipid indices, such as atherogenic index of plasma (AIP), visceral adiposity index (VAI) and lipid accumulation p...

Objective In 2010, a questionnaire-based study on obstructive sleep apnea (OSA) management in Europe identified differences regarding reimbursement, sleep specialist qualification, and titration procedures. Now, 10 years later, a follow-up study was conducted as part of the ESADA (European Sleep Apnea Database) network to explore the development of...

For more than a decade, NMDAR autoimmune encephalitis has been studied and treated as a neurological condition, and good results have been achieve through immune therapies. Apart from being well represented in the CNS, NMDA receptors are currently known of and being studied in multiple non-neuronal cells with potential clinical significance. The as...

The optimal use of drug combinations for the management of asthma is providing significant results. This has prompted INTERASMA (Global Asthma Association) to take a position on inhaled triple therapy in asthma. Starting from an extensive literature review, Interasma executive committee discussed and approved this Manifesto, developed by Interasma...

Obstructive sleep apnoea (OSA) and asthma are two common respiratory disorders in children and adults. Apart from common risk factors, such as obesity, gastroesophageal reflux disease and allergic rhinitis, emerging evidence suggest that the two diseases may complicate the clinical course of each other. On one hand, OSA modifies asthmatic airway in...

Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patient...

Obstructive sleep apnoea (OSA) is associated with increased insulin resistance. Triglyceride-glucose index (TyG) is a simple marker of insulin resistance; however, it has been investigated only by two studies in OSA. The aim of this study was to evaluate TyG in non-diabetic, non-obese patients with OSA. A total of 132 patients with OSA and 49 non-O...

The large amount of evidence and the renewed interest on upper and lower airways involvement in infectious and inflammatory diseases has led Interasma (Global Asthma Association) to take a position on United Airways Diseases (UAD). Starting from an extensive literature review, Interasma excecutive committee discussed and approved this Manifesto dev...

Background: Dyslipidaemia is well recognised in obstructive sleep apnoea (OSA) and could contribute to the development of cardiovascular disease (CVD). Atherogenic index of plasma (AIP) predicts cardiovascular morbidity and mortality better than the individual lipid levels. The aim of this study was to investigate the AIP in patients with OSA in r...

We explored the relationship between obstructive sleep apnea (OSA) patients’ anthropometric measures and the CPAP treatment response. To that end, we processed three non-overlapping cohorts (D1, D2, D3) with 1046 patients from four sleep laboratories in Western Romania, including 145 subjects (D1) with one-night CPAP therapy. Using D1 data, we crea...

We defined gender-specific phenotypes for men and women diagnosed with obstructive sleep apnea syndrome (OSAS) based on easy-to-measure anthropometric parameters, using a network science approach. We collected data from 2796 consecutive patients since 2005, from 4 sleep laboratories in Western Romania, recording sleep, breathing, and anthropometric...

Background and Purpose An accurate determination of the cardioembolic risk in patients with atrial fibrillation (AF) is crucial to prevent consequences like stroke. Obstructive sleep apnea (OSA) is a known risk factor for both AF and stroke. We aim to explore a possible association between OSA and an increased cardioembolic risk in patients with AF...

Background: Obstructive sleep apnea (OSA) is usually associated with cardiovascular and cerebrovascular disease, metabolic syndrome and depression. Data on relevant OSA-associated comorbidities in Central-European populations are scarce. The aim of this study was to compare the prevalence of comorbidities in two OSA cohorts from Hungary and Romani...

Introduction: Overlap syndrome (OVS) is defined by the coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in the same patient. This condition is associated with increased mortality and a higher risk of respiratory exacerbation, compared to patients with COPD or OSA alone. Dedicated studies are required to...

Introduction: Chronic kidney disease (CKD) is frequent in high cardiovascular risk (HCVR) patients and is associated with poor outcomes. Obstructive sleep apnea (OSA) is common both in CKD and HCVR patients and further worsens the prognosis. We sought to determine the sleep characteristics and the risk for OSA in HCVR patients with or without renal...

Introduction: Smoking is a major contributor to the cardiovascular disease (CVD) and causes approximately one in every four deaths from CVD, a risk that increases with the number of cigarettes smoked per day and prolonged period of smoking. Method: We evaluated 299 consecutive adult patients hospitalized for acute myocardial infarction (MI) or uns...

Background: We sought to investigate whether long-term continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) and resistant hypertension (RHTN) could attenuate the cardiovascular disease risk by lowering their body-mass index (BMI). Methods: This was a long-term observational study of RHTN patients di...

Background: Severe asthma is a serious condition with a significant burden on patients' morbidity, mortality, and quality of life. Some biological therapies targeting the IgE and interleukin-5 (IL5) mediated pathways are now available. Due to the lack of direct comparison studies, the choice of which medication to use varies. We aimed to explore t...

Occupational asthma (OA) represents one of the major public health problems due to its high prevalence, important social and economic burden. The aim of this review is to summarize current data about clinical phenotypes, biomarkers, diagnosis and management of OA, a subtype of work-related asthma. Most studies have identified two phenotypes of OA....

Introduction: Obesity-associated asthma (OA) is frequently severe, difficult to control, with an increased rate of hospitalizations, numerous comorbidities and low response to corticosteroids. Despite progress in applying the personalized medicine in asthma, no specific recommendations exist for the management of OA. Areas covered: The aim of th...

Heart failure (HF) remains a major public health issue despite advances in treatment, being associated with increased morbidity and mortality, multiple hospitalization and, implicitly, very high economic costs. Therefore, it becomes increasingly important to identify and treat factors or comorbidities that contribute to the progression of HF. Breat...

Background and objectives: Obstructive sleep apnea syndrome (OSAS) and heart failure (HF) are increasing in prevalence with a greater impact on the health system. The aim of this study was to assess the particularities of patients with OSAS and HF, focusing on the new class of HF with mid-range ejection fraction (HFmrEF, EF = 40%-49%), and comparin...

Background: Patients with sleep apnea syndrome (SAS) and heart failure (HF) have concomitant different comorbidities and increased risk of morbidity. Aim: The aim of this study was to analyze differences between patients with SAS and heart failure with preserved ejection fraction (HFpEF; ejection fraction [EF]≥50%) – group 1 and those with SAS and...

Ear, nose and throat (ENT) comorbidities are common in patients with asthma and are frequently associated with poorer asthma outcomes. All these comorbidities are “treatable traits” in asthma. Identification and management of these disorders may spare medication usage and contribute to improved asthma control and quality of life, and a decrease in...

Introduction: Asthma and allergic rhinitis (AR) are chronic conditions in which management needs adherence to prescribed drugs. Despite the benefits of regular maintenance of asthma and AR therapy, low adherence is a frequent issue in clinical practice. Areas covered: The aim of this review is to provide a targeted analysis of the more recent liter...

Proposal This paper investigates a novel screening tool for Obstructive Sleep Apnea Syndrome (OSAS), which aims at efficient population-wide monitoring. To this end, we introduce SASscore which provides better OSAS prediction specificity while maintaining a high sensitivity. Methods We process a cohort of 2595 patients from 4 sleep laboratories in...

AHI and relevant risk factor parameters distribution. The distribution of AHI values and relevant risk factor parameters distribution in the WestRo—Western Romania dataset (N = 2595 subjects), given as average values and standard deviation. (PDF)

Anthropometric measurements distributions. Distributions of AHI, body mass index (BMI), age, neck circumference (Neck), systolic blood pressure (SysBP), and Epworth sleepiness score (ESS) in the WestRo cohort. The results show that, given that the database contains subjects from a well-delimited geographical area which were randomly gathered, the m...

Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in amelior...

Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in amelior...

Purpose of review: Target therapy is the necessary step towards personalized medicine. The definition of asthma phenotypes and underlying mechanisms (endotypes) represent a key point in the development of new asthma treatments. Big data analysis, biomarker research and the availability of monoclonal antibodies, targeting specific cytokines is lead...

Obstructive sleep apnea syndrome (OSAS) is a common clinical condition. The way that OSAS risk factors associate and converge is not a random process. As such, defining OSAS phenotypes fosters personalized patient management and population screening. In this paper, we present a network-based observational, retrospective study on a cohort of 1,371 c...

Patient databases used in the paper This archive contains 2 xlsx files with the following databases: Apnea Patients Database (APD), Test Database (TD), and Non-osAs Database (NAD).

Gephi files with the networks in the paper Archive containing the files with layout representations for the networks that are described in the paper. In order to visualize the .gephi files, the Gephi package has to be downloaded from https://gephi.org/ and installed.

Background E-cigarettes are the most commonly used non-tobacco nicotine delivery devices and their use is increasing among adolescents worldwide. Objective To explore predictors of e-cigarette experimentation among adolescents in Tîrgu Mures, Romania. To assess the impact of the curriculum on e-cigarette use. Methods Design and sample: This was a...

Statistical analysis of anthropometric differences between COPD stages 1 and 2.

Background: Affective disturbances can influence the attitude toward smoking in patients with various diseases. This study aims to assess the level of anxiety and its influence on smoking behavior in a group of adult patients with community-acquired pneumonia (CAP). Methods: The study included 64 smokers with CAP admitted in the Clinic of Infectiou...

Introduction. The smoking score (SS), clinically known as pack-years (Prignot, J. Eur J Respir Dis 1987; 70:1–7), is used in order to account for the effects of readymade cigarettes smoking. Objectives. For a person that quits smoking, SS is the same as the score during the smoking period. Therefore, SS does not reflect the benefits of quitting smo...