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General Reviews

Association between the serum level of testosterone and other comorbidities in obstructive sleep apnea

Raluca Bercea1,2, Bogdan Bercea3, Traian Mihăescu1,2
1. Universitatea de Medicină şi Farmacie „Grigore T. Popa” Iaşi, România; 2. Spitalul Clinic de Pneumoftiziologie Iaşi, România; 3. Spitalul Clinic „Dr. C. I. Parhon”, Clinica de Urologie şi Transplant Renal, Iaşi, România


Testosterone seems to play a role in the pathophysiology of OSAS but the mechanisms are not yet well defined. Research of this relationship has focused on two main assumptions: first case support the emergence of OSAS or augmentation of OSAS severity in men treated with testosterone for symptomatic hypogonadism; the second hypothesis suggest that serum testosterone deficiency is due to hypoxia and microarousals generated by OSAS with direct impact on hypothalamic-pituitary-gonadal axis. The correlation between sleep apnea and androgenic disorders should be considered in the light of the intervention of many other factors which can act as confounding factors: age, obesity and other associated pathologies (chronic lung disease, smoking status). Many studies conducted so far on this interrelation (sleep apnea, endocrine system) have ignored these factors. In most cases CPAP (continuous positive airway pressure) therapy revert low serum testosterone levels to normal levels. Depressive status and fatigue, as OSAS consequences associated with hypogonadism have been reported in the literature and may have clinically significant aspects due to summary effect, with notable improvement after CPAP therapy avoiding adverse effects of hormonal or antidepressant treatment. The clinical implications and major consequences of association between androgen dysfunction and sleep apnea syndrome require a correct management in the recognition and treatment of obstructive sleep apnea syndrome associated with comorbidities.

Keywords: OSAS, testosterone, comorbidities

The role of allergological tests in Allergic Bronchopulmonary Aspergillosis (ABPA)

Roxana Silvia Bumbăcea1,2, Ileana Ghiordănescu2, Brînduşa Petruţescu2
1. UMF “Carol Davila”, Bucureşti; 2. Spitalul Universitar de Urgenţă Elias, Bucureşti - Compartimentul Alergologie


The role of allergological tests in Allergic Bronchopulmonary Aspergillosis (ABPA) Allergic Bronchopulmonary Aspergillosis (ABPA) is an uncommon respiratory condition in which Asp. spp spores and mycelia inhalation trigger an immuno allergic inflammatory response in the bronchial airways. ABPA mostly develops in asthmatic and cystic fibrosis patients. The true prevalence of ABPA in not known. It is important to exclude ABPA in all asthmatics with positive skin reactivity to Aspergillus. Currently, a number of allergens from A. fumigatus have been cloned and the mRNA was purified - these are the recombinant antigens which can be used to distinguish between ABPA and fungal sensitization. IgE specific for Asp f 4 and Asp f 6 are restricted to ABPA patients and have a sensitivity and specificity of 90% and 100%, respectively. Aspergillus hipersensitivity can be demonstrated using in vivo (skin prick test) and in vitro methods (specific Ig E and Ig G, serum precipitins). In ABPA skin prick test is almost always positive. Normal levels of total IgE exclude ABPA. Serum total and specific Ig E vary according to disease activity and are usefull for monitoring the treatment.

Keywords: Allergic Bronchopulmonary Aspergillosis, asthma, cystic fibrosis, hipersensitivity, serological tests, skin prick test

Adherence to CPAP - “eternal” issue

Fl. Mihălţan1, Oana Deleanu1, Ioana Munteanu1, Ruxandra Ulmeanu1, Roxana Nemeş1, Mihaela Oros2
1. Institutul de Pneumologie „M. Nasta” - Bucureşti; 2. Spitalul Medicover - Bucureşti


Adherence to CPAP is and will remain the touchstone for patients with obstructive sleep apnea syndrome. The authors try to clarify the many difficulties encountered regarding this matter, its epidemiological implications, factors predicting non-adherence to treatment, and which are the most effective ways to alleviate it. Therefore a practitioner can increase the degree of adherence and he can decisively influence the favourable effect of this type of therapy on a short-term as well as long-term basis.

Keywords: non-adherence, obstructive sleep apnea syndrome