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BackgroundIt has been reported that the clinical expression of obstructive sleep apnea (OSA) may differ in women and men.ObjectiveThe objective of this study was to evaluate the influence of gender on reported OSA-related symptoms in a large clinical population of patients.MethodsThe database from the sleep laboratory of a tertiary care center was examined. Adult patients who had undergone a diagnostic polysomnography and completed the Berlin questionnaire, a sleep questionnaire, and the Epworth sleepiness scale were selected. Multiple logistic regression analysis was performed to assess the relationship between OSA-associated symptoms and different potential explanatory variables.ResultsThe study sample included 1084 patients, median age was 53 years, 46.5% (504) were women, 72.7% (788) had OSA (apnea/hypopnea index ≥ 5), and 31.2% were obese. After adjusting for age, body mass index, and apnea/hypopnea index, men were more likely to report snoring (OR 4.06, p < 0.001), habitual or loud snoring (OR 2.34, p < 0.001; 2.14, p < 0.001, respectively) and apneas (OR 2.44, p < 0.001), than women. After controlling for multiple variables, female gender was an independent predictive factor for reported tiredness (OR 0.57, p 0.001), sleep onset insomnia (OR 0.59, p 0.0035), and morning headaches (OR 0.32, p < 0.001). Reports of excessive daytime sleepiness, nocturia, midnight insomnia, and subjective cognitive complaints were not significantly associated with gender.ConclusionWomen with OSA were more likely to report tiredness, initial insomnia, and morning headaches, and less likely to complain of typical OSA symptoms (snoring, apneas) than men.

Background Patients under treatment with continuous positive airway pressure (CPAP) may have residual sleep apnea (RSA). Objective The main objective of our study was to evaluate a novel auto-CPAP for the diagnosis of RSA. Methods All patients referred to the sleep laboratory to undergo CPAP polysomnography were evaluated. Patients treated with oxygen or noninvasive ventilation and split-night polysomnography (PSG), PSG with artifacts, or total sleep time less than 180 min were excluded. The PSG was manually analyzed before generating the automatic report from auto-CPAP. PSG variables (respiratory disturbance index (RDI), obstructive apnea index, hypopnea index, and central apnea index) were compared with their counterparts from auto-CPAP through Bland–Altman plots and intraclass correlation coefficient. The diagnostic accuracy of autoscoring from auto-CPAP using different cutoff points of RDI (≥5 and 10) was evaluated by the receiver operating characteristics (ROCs) curve. Results The study included 114 patients (24 women; mean age and BMI, 59 years old and 33 kg/m 2 ; RDI and apnea/hypopnea index (AHI)-auto median, 5 and 2, respectively). The average difference between the AHI-auto and the RDI was −3.5 ± 3.9. The intraclass correlation coefficient (ICC) between the total number of central apneas, obstructive, and hypopneas between the PSG and the auto-CPAP were 0.69, 0.16, and 0.15, respectively. An AHI-auto >2 (RDI ≥ 5) or >4 (RDI ≥ 10) had an area under the ROC curve, sensitivity, specificity, positive likelihood ratio, and negative for diagnosis of residual sleep apnea of 0.84/0.89, 84/81 %, 82/91 %, 4.5/9.5, and 0.22/0.2, respectively. Conclusions The automatic analysis from auto-CPAP (S9 Autoset) showed a good diagnostic accuracy to identify residual sleep apnea. The absolute agreement between PSG and auto-CPAP to classify the respiratory events correctly varied from very low (obstructive apneas, hypopneas) to moderate (central apneas).

Foliar development involves successive phases of cell proliferation and expansion that determine the final leaf size, and is characterized by an early burst of reactive oxygen species (ROS) generated in the photosynthetic electron transport chain (PETC). Introduction of the alternative PETC acceptor flavodoxin in tobacco chloroplasts led to a reduction in leaf size associated to lower cell expansion, without affecting cell numbers per leaf. Proteomic analysis showed that components of the light-harvesting systems accumulated before electron-transport proteins, suggesting a mechanism for the early oxidative event. Flavodoxin expression did not affect biogenesis of the PETC but prevented ROS build-up through its function as electron sink. Mature leaves from flavodoxin-expressing plants were shown to contain higher levels of transcripts encoding components of the proteasome, a key negative modulator of organ size. Proteome profiling revealed that this differential accumulation initiated during expansion and led to increased proteasomal activity, whereas a proteasome inhibitor reverted the flavodoxin-dependent size phenotype. Cells expressing plastid-targeted flavodoxin displayed lower endoreduplication, also associated to decreased organ size. These results provide novel insights into the regulation of leaf growth by chloroplast-generated redox signals, and highlight the potential of alternative electron shuttles to investigate novel link(s) between photosynthesis and plant development. Modification of chloroplast redox status by expression of the cyanobacterial alternative electron sink flavodoxin decreased leaf cell expansion, which was associated with higher proteasome activity and lower endoreduplication.

Light significantly influences plant stress responses, with chloroplasts playing a pivotal role as both energy providers and light sensors. They communicate with the nucleus through retrograde signals, including secondary metabolites and reactive oxygen species (ROS). To investigate the contribution of chloroplast redox biochemistry to biotic responses, we studied the interactions of tobacco leaves expressing the alternative electron shuttle flavodoxin with virulent and nonhost Pseudomonas syringae pathovars under light and dark conditions. Flavodoxin is reported to limit light-dependent ROS propagation and over-reduction of the photosynthetic electron transport system under stress. Light intensified the hypersensitive response against the nonhost pathovar tomato (Pto), but slowed disease progression caused by the virulent pathovar tabaci (Pta). Flavodoxin mitigated light responses during both interactions, including decreased ROS levels, reduced stromule occurrence, and lower phytoalexin production, with different signatures depending on the pathovar. Similar leaf metabolic profiles were observed in the dark for both strains, with a general up-regulation of sugars, metabolic intermediates, and amino acids. In the light, instead, Pta increased sugars and intermediates, while Pto decreased them. Our results suggest that HR-like responses are elicited in the light even during virulent interactions, and that light effects are related to signals originating at the photosynthetic machinery. - Light inhibits disease progression during a tobacco-Pseudomonas virulent interaction. - Light exacerbates the hypersensitive response (HR) during a nonhost interaction. - HR-like responses are elicited in the light even during virulent interactions. - Plastid-targeted flavodoxin decreases plant damage only in photoperiod. - The chloroplast redox state modulates plant biotic response.

Leaf growth is sustained by successive phases of cell proliferation and expansion that determine the final organ size. The rate and extension of these phases are modulated by several developmental and environmental cues. We show herein that changes in the redox status of tobacco chloroplasts caused by introduction of the alternative electron shuttle flavodoxin led to decreased leaf size. Flavodoxin activity as electron sink prevented over-reduction of the photosynthetic electron transport chain and propagation of reactive oxygen species. These effects correlated with significantly lower rates of cell expansion in leaves of flavodoxin-expressing plants. Neither the duration of the expansion phase nor the rate and extension of the proliferative stage were affected by the presence of the alternative electron carrier, resulting in smaller leaf cells without significant differences in their numbers. Cells from transformed plants contained fewer chloroplasts of wild-type size, but their cellular coverage was increased due to cell size reduction. Chloroplast redox modulation of leaf development was associated to increased proteasomal activity and lower endoreduplication. The results identify a new player in the global regulation of plant organ growth, as represented by plastid-generated redox signals, and underscore the value of alternative electron shuttles to investigate the signaling role of chloroplast oxido-reductive biochemistry in plant developmental pathways. Competing Interest Statement The authors have declared no competing interest.