Translational research in respiratory medicine group

Obstructive Sleep Apnea: outcomes, treatments and personalized strategies

Obstructive Sleep Apnea (OSA) is a highly prevalent chronic disorder characterized by recurrent episodes of upper airway collapse during sleep, leading to intermittent hypoxia and sleep fragmentation. These alterations activate intermediate pathophysiological mechanisms such as oxidative stress, sympathetic nervous system activation, systemic inflammation, and endothelial dysfunction, significantly increasing the risk of cardiovascular and metabolic diseases.

OSA is a markedly heterogeneous condition encompassing multiple causal pathways, distinct clinical phenotypes, and variable health outcomes. Likewise, patients' responses to continuous positive airway pressure (CPAP), the first-line treatment for this disease, vary widely.

The main objectives of this research line are:
- i) to evaluate the impact of OSA and its treatment on blood pressure regulation and cardiovascular disease, identifying predictors of adverse outcomes and treatment response;
- ii) to identify patient profiles at higher risk of complications and those most likely to benefit from treatment implementation; and
- iii) to explore and assess therapeutic options beyond CPAP, with special attention to populations underrepresented in clinical research, including older adults, postmenopausal women, and pregnant women.

Sleep and circadian health

Sleep is increasingly recognized as a fundamental pillar of health, alongside nutrition, physical activity, and emotional well-being. Poor sleep quality and circadian rhythm disruption are associated with a wide range of adverse short- and long-term outcomes.

Acute consequences include excessive daytime sleepiness, reduced cognitive and occupational performance, and an increased risk of traffic and workplace accidents. Chronic sleep and circadian disturbances contribute to the onset and progression of multiple pathologies, including obesity, diabetes, cardiovascular diseases, and neurodegenerative disorders such as Alzheimer's and Parkinson's diseases.

The main objectives of this research line are:
- i) to evaluate the impact of sleep and circadian rhythm disturbances in different clinical conditions, including neurodegenerative diseases, COVID-19, and critical illness;
- ii) to identify predictive factors associated with sleep and circadian health deterioration in these populations;
- iii) to develop and validate feasible and cost-effective sleep and circadian health markers;
- iv) to investigate the biological and physiological mechanisms underlying sleep and circadian rhythm disturbances;
- v) to monitor sleep habits and circadian health at the population level in Catalonia; and
- vi) to promote dissemination and awareness activities to increase public understanding of the importance of sleep and circadian health.

COVID-19: clinical impact, molecular aspects and novel biomarkers

The COVID-19 pandemic has had a dramatic impact on global public health in recent years. COVID-19 is a heterogeneous disease ranging from asymptomatic infection to critical illness and fatal outcomes. It is estimated that up to 20-30% of patients with COVID-19 develop severe complications leading to hospitalization, intensive care unit admission, increased mortality risk, and a high prevalence of post-acute sequelae.

Overall, the objectives of this research line are:
- i) to identify clinical predictors associated with adverse clinical outcomes;
- ii) to decipher clinical phenotypes linked to adverse outcomes and the presence of post-acute sequelae in hospitalized patients, including critically ill patients;
- iii) to build prognostic models to improve medical decision-making in hospitalized and critically ill patients, including prognosis and treatment response;
- iv) to identify molecular mechanisms associated with adverse outcomes during the acute phase and with post-acute sequelae; and
- v) to identify novel biomarkers to improve medical decision-making during the acute phase of the disease and in patients with Post-COVID, including prognosis and treatment response.

Lung cancer screening

Following the COVID-19 pandemic, the research group has redirected its activity toward lung cancer screening, consolidating one of its most solid and promising lines of work in recent years. This line combines participation in international initiatives such as the International Early Lung Cancer Action Program (I-ELCAP) and the Initiative for Early Lung Cancer Research on Treatment (I-ELCART), with a clearly multidisciplinary approach integrating pulmonology, radiology, nursing, biostatistics, and health economic evaluation.

The group maintains close collaborations with reference centers such as Mount Sinai Hospital and Jacobi Medical Center (New York), which has strengthened capabilities in advanced thoracic imaging and enabled the development of new joint projects. Current research focuses on:
- Identification and validation of biomarkers
  Study of clinical, radiological, and analytical biomarkers to improve risk stratification, optimize inclusion criteria in screening programs, and refine the interpretation of detected pulmonary nodules.
- Bioinformatics and radiomics applied to medical imaging
  Application of radiomics techniques and computational analysis for the extraction of radiomic profiles, automated segmentation of pulmonary nodules, and the development of predictive survival models.
- Cost-effectiveness evaluation and implementation
  Economic analysis of screening implementation in real healthcare settings, with special emphasis on efficiency, sustainability, and public health impact.
- Opportunistic diagnosis of pathologies
  Use of low-dose computed tomography for the early detection of other respiratory and systemic diseases, expanding the clinical value of screening.
- Implementation and evaluation of organizational screening models
  Study of care pathways, multidisciplinary coordination, and operational models required for effective population-level screening implementation.

Management of obstructive sleep apnoea in older adults with overweight or obesity

Study of clinical management strategies for obstructive sleep apnoea in older adults, particularly in individuals with overweight or obesity, with the aim of optimizing diagnostic and therapeutic approaches in this population. This research line addresses the disease from a multidimensional perspective, investigating the effectiveness and adherence to standard therapies, such as continuous positive airway pressure (CPAP), as well as the potential of new therapeutic strategies, including pharmacological treatments targeting obesity and multidisciplinary interventions aimed at lifestyle modification.
- I) Impact of GLP-1 receptor agonists on obstructive sleep apnea
  
  Subcategory focused on studying the role of pharmacological treatments targeting obesity, particularly GLP-1 receptor agonists, by analyzing the relationship between drug-induced weight loss and improvement of obstructive sleep apnea in older adults with overweight or obesity.

Airway: Study of chronic respiratory diseases such as COPD and bronchiectasis.

Clinical and translational research in chronic airway diseases, with a particular focus on COPD and bronchiectasis, including chronic bronchial infection. Aimed at phenotypic characterization, biomarker identification, the study of exacerbations and respiratory microbiology, as well as the evaluation of personalized therapeutic strategies, including pharmacological interventions and structured respiratory physiotherapy programs.