Titulación domiciliaria en pacientes con apnea del sueño mediante dos dispositivos de CPAP automática: mismo modo, distintos resultados / CPAP home titration with two different devices: same mode, different results

INTRODUCCIÓN: Dada la gran prevalencia de apnea obstructiva del sueño (AOS) y las dificultades del cumplimiento, es necesario buscar un sistema que permita ajustar el nivel de presión de CPAP para cada paciente. Actualmente, la técnica más utilizada es emplear dispositivos de auto-CPAP capaces de analizar la respuesta del paciente y modificar la presión automáticamente, pero no se tiene en consideración las diferencias entre máquinas. El objetivo del estudio fue comparar los resultados de pruebas de titulación realizadas con dos dispositivos distintos para conocer si existían diferencias entre ellos. MÉTODOS: Estudio observacional retrospectivo que compara los resultados de 1.130 titulaciones automáticas domiciliarias realizadas en una noche con dos dispositivos: S9 AutoSetTM (S9) y DreamStation AutoCPAP (DS). Se determinó la presión óptima por análisis visual y el cumplimiento a 12 meses. RESULTADOS: Se incluyeron 870 pacientes a los que se realizaron 1.130 titulaciones. Los estudios válidos con DS fueron significativamente superiores (OR= 2,5; IC 95%: 1,9 a 3,2). Además, tanto la presión de titulación visual como la automática P90-95 fueron significativamente menores con la DS que con S9 [-1,9 cm H2O (IC: -2,2 a -1,6)] y [-2,2 cm H2O (IC: -2,6 a -1,9)] respectivamente, (p< 0,001). No se objetivó impacto en el cumplimiento. CONCLUSIONES: Los resultados reflejan que las CPAP automáticas no son iguales ni ofrecen los mismos resultados. Realizar una titulación con el dispositivo DS hace más probable que el estudio sea válido y se obtienen presiones más bajas. Se deberán realizar estudios específicos para conocer el porqué de las diferencias y evaluar su impacto clínico

INTRODUCTION: Due to the high prevalence of obstructive sleep apnea (OSA) and compliance difficulties, it is necessary to find a system for adjusting the CPAP pressure level for each patient. Currently, the most widely used technique is to use auto-CPAP devices which can analyze the patient's response and automatically modify the pressure. However differences between machines are not taken into account. The aim of the study was to compare the results of titration tests carried out with two different devices to find out whether there were differences between them. METHODS: Retrospective observational study comparing the results of 1,130 home automatic titrations performed over one night with two devices: S9 AutoSetTM (S9) and DreamStation AutoCPAP (DS). Optimal pressure was determined by visual analysis and compliance at 12 months. RESULTS: 870 patients were included and 1,130 titrations were carried out. Valid studies with DS were significantly higher (OR= 2.5; 95% CI: 1.9 to 3.2). Furthermore, both visual and automatic titration pressure P90-95 were significantly lower with DS than with S9 [-1.9 cm H2O (CI: -2.2 to -1.6)] and [-2.2 cm H2O (CI: -2.6 to -1.9)] respectively, (p< 0.001). No impact on compliance was observed. CONCLUSIONS: The results saw that neither automatic CPAPs are the same nor offer the same results. Performing a titration with the DS device not only makes the study more likely to be valid but also lower pressures are obtained. Specific studies should be carried out to find out the reason for the differences and evaluate their clinical impact

[Quality of life and associated characteristics of restless legs syndrome in the adult population of Burgos, Spain]. / Calidad de vida y caracteristicas asociadas del sindrome de piernas inquietas en la poblacion adulta de Burgos, España.

INTRODUCTION: Restless legs syndrome (RLS) is a neurological disorder with a prevalence of up to 15%, although little is known about its impact upon quality of life. AIM: To analyse the impact of RLS on health-related quality of life. SUBJECTS AND METHODS: A descriptive cross-sectional study. A random sample of 1,275 subjects over 18 years old, stratified by age, was taken from the urban area of Burgos, with an estimated prevalence, 10%; alpha, 5%; accuracy, 3%; and losses, 70%, using a two-phase study (screening and diagnosis of cases of RLS and non-cases confirmed by a doctor). The clinical and sociodemographic data were collected by means of semi-structured questionnaires, the European Quality of Life-5 Dimensions, the Restless Legs Syndrome Quality of Life Questionnaire, the Epworth Scale, the Goldberg Scale, the Sleep Scale and the International Restless Legs Syndrome Rating Scale. RESULTS: The prevalence of RLS was 5.6% (CI 95%: 2.5-8.7%). Of the total number of cases, 79.4% were women and only 7% had been previously diagnosed with RLS. Intense pain, insomnia and depression-anxiety were more frequent among the cases of RLS than in the controls (p < 0.001 in the three cases). The quality of life among the cases of RLS, especially in women, was poorer than among the controls (p < 0.001). For 11.7% of the cases, RLS made it difficult for the patients to work. CONCLUSIONS: RLS is associated with depression-anxiety, with a significant impact on sleep, on social and work relationships, and on the health-related quality of life.

TITLE: Calidad de vida y caracteristicas asociadas del sindrome de piernas inquietas en la poblacion adulta de Burgos, España.Introduccion. El sindrome de piernas inquietas (SPI) es un trastorno neurologico con una prevalencia de hasta un 15%, cuyo impacto sobre la calidad de vida resulta poco conocido. Objetivo. Analizar el impacto del sindrome de piernas inquietas (SPI) en la calidad de vida relacionada con la salud. Sujetos y metodos. Estudio descriptivo transversal. Se incluyo una muestra aleatoria, estratificada por edad, de 1.275 sujetos mayores de 18 años en el area urbana de Burgos, con las estimaciones de prevalencia, 10%; alfa, 5%; precision, 3%; y perdidas, 70%, usando un estudio en dos fases (cribado y confirmacion diagnostica de casos de SPI y no casos por un medico). Los datos clinicos y sociodemograficos se recogieron usando cuestionarios semiestructurados: European Quality of Life-5 Dimensions, Restless Legs Syndrome Quality of Life Questionnaire, escala de Epworth, escala de Goldberg, escala del sueño y cuestionario internacional del sindrome de piernas inquietas. Resultados. La prevalencia del SPI fue del 5,6% (IC 95%: 2,5-8,7%). El 79,4% de los casos eran mujeres; solo el 7% tenia un diagnostico previo de SPI. El dolor intenso, el insomnio y la depresion-ansiedad fueron mas frecuentes en los pacientes con SPI que en los controles (p < 0,001 en los tres casos). La calidad de vida entre los pacientes con SPI, especialmente en las mujeres, fue peor que en los controles (p < 0,001). En el 11,7% de los casos, el SPI produjo dificultades para trabajar. Conclusiones. El SPI esta asociado con ansiedad-depresion, con un significativo impacto en el sueño, en las relaciones sociales y laborales, y en la calidad de vida relacionada con la salud.

Eficacia de la adenoamigdalectomía en el síndrome de apneas-hipopneas durante el sueño valorada mediante poligrafía respiratoria / Evaluation of the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome in children using respiratory polygraphy

Objetivo: Evaluar la eficacia del tratamiento quirúrgico mediante adenoamigdalectomía en el síndrome de apnea-hipopnea durante el sueño (SAHS) en la infancia mediante poligrafía respiratoria (PR). Material y métodos: Estudio prospectivo en niños menores de 14 años remitidos con la sospecha clínica de SAHS. A todos ellos se les realizó una historia clínica, examen físico general y otorrinolaringológico, así como PR previa a la adenoamigdalectomía y 6 meses después. Se excluyeron los síndromes cráneo-faciales, las alteraciones neuromusculares y la enfermedad concomitante grave. Resultados: Se estudiaron 150 casos (67,3% varones), con una edad media de 3,74±1,80 años y un percentil de IMC de 41,70±31,75, diagnosticados de SAHS, cuando el número total de eventos respiratorios, apneas más hipopneas, dividido por el tiempo total del estudio (IER) era mayor de 4,6, mediante PR previa a la cirugía. El IER medio fue de 15,18±11,11; del total, 58,7% (88) presentaba un SAHS grave (IER>10). Después de 6 meses tras la cirugía, mejoraron todos los parámetros clínicos y poligráficos. Persistió enfermedad (IER>4,6) en 21 pacientes (14%). Ninguno de ellos presentó IER>10 tras la cirugía. El IER preoperatorio se relacionó significativamente con la persistencia de enfermedad (p=0,042). Conclusiones: La PR es útil para monitorizar la eficacia del tratamiento quirúrgico mediante adenoamigdalectomía en el SAHS infantil (AU)

Objetive: To evaluate the effectiveness of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) in children by respiratory polygraphy (RP). Material and methods: Prospective study was conducted on children referred with clinical suspicion of OSAHS. A clinical history was taken and a general physical and ENT examination was performed on all patients. RP was performed before adenotonsillectomy and six months afterwards. Patients with craniofacial syndromes, neuromuscular disorders, and severe concomitant disease were excluded. Results: We studied 150 children (67. 8% male), with a mean age of 3.74±1.80 years and a BMI of 41.70±31.75. A diagnosis of OSAHS was made if the total number of respiratory events, apneas and hypopneas, divided by the total study time (RDI) was > 4.6, using RP before undergoing adenotonsillectomy. The mean respiratory disturbance index (RDI) was 15.18±11.11, with 58.7% (88) of with severe OSAHS (RDI>10). There was a significant improvement in all clinical and polygraphic variables six months after adenotonsillectomy. The residual OSAHS was 14%. The preoperative RDI was significantly associated with persistent disease (P=0.042). Conclusions: Respiratory polygraphy is useful for monitoring the efficacy of surgical treatment by adenotonsillectomy in children with OSAHS (AU)

[Evaluation of the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome in children using respiratory polygraphy]. / Eficacia de la adenoamigdalectomía en el síndrome de apneas-hipopneas durante el sueño valorada mediante poligrafía respiratoria.

OBJECTIVE: To evaluate the effectiveness of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) in children by respiratory polygraphy (RP). MATERIAL AND METHODS: Prospective study was conducted on children referred with clinical suspicion of OSAHS. A clinical history was taken and a general physical and ENT examination was performed on all patients. RP was performed before adenotonsillectomy and six months afterwards. Patients with craniofacial syndromes, neuromuscular disorders, and severe concomitant disease were excluded. RESULTS: We studied 150 children (67. 8% male), with a mean age of 3.74±1.80 years and a BMI of 41.70±31.75. A diagnosis of OSAHS was made if the total number of respiratory events, apneas and hypopneas, divided by the total study time (RDI) was > 4.6, using RP before undergoing adenotonsillectomy. The mean respiratory disturbance index (RDI) was 15.18±11.11, with 58.7% (88) of with severe OSAHS (RDI>10). There was a significant improvement in all clinical and polygraphic variables six months after adenotonsillectomy. The residual OSAHS was 14%. The preoperative RDI was significantly associated with persistent disease (P=.042). CONCLUSIONS: Respiratory polygraphy is useful for monitoring the efficacy of surgical treatment by adenotonsillectomy in children with OSAHS.

Atributos psicométricos de la versión española de la escala de cribado A-TAC para trastornos del espectro autista / Psychometric attributes of the spanish version of A-TAC screening scale for autism spectrum disorders

Introducción: Actualmente debido a la ausencia de marcadores biológicos, el cribado de trastornos del espectro autista (TEA) se centra fundamentalmente en la presencia de alteraciones conductuales caracterizadas por alteraciones en la interacción social y comunicación verbal y no verbal. Objetivo: Evaluar los atributos psicométricos de la versión española de la escala de autismo Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC), como medida de cribado de TEA. Material y métodos: Se incluyó en el estudio a 140 escolares (43% niños, 57% niñas), de edades comprendidas entre los 6 y los 16 años, con TEA (n = 15), discapacidad intelectual (n = 40), enfermedades psiquiátricas (n = 22), tics (n = 12) y participantes controles (n = 51). Se analizaron los principales atributos psicométricos como la fiabilidad, asunción escalar, la consistencia interna, la precisión y la validez predictiva. Resultados: La consistencia interna de la A-TAC fue alta (α = 0,93) y el error estándar de medida fue adecuado (1,13 [intervalo de confianza del 95%, —1,08 a 3,34]). Las puntuaciones medias de la escala A-TAC fueron más altas en participantes diagnosticados con TEA y discapacidad intelectual comparadas con el resto de participantes (p < 0,001), siendo el área bajo la curva de 0,96 para el grupo de TEA. Conclusión: La subescala de autismo de la escala A-TAC es un instrumento fiable, válido y preciso para el cribado de TEA en la población escolar española (AU)

Background: As there are no biological markers for Autism Spectrum Disorders (ASD), screening must focus on behaviour and the presence of a markedly abnormal development or a deficiency in verbal and non-verbal social interaction and communication. Objective: To evaluate the psychometric attributes of a Spanish version of the autism domain of the Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC) scale for ASD screening. Material and methods: A total of 140 subjects (43% male, 57% female) aged 6-16, with ASD (n = 15), Mental Retardation (n = 40), Psychiatric Illness (n = 22), Tics (n = 12) and controls (n = 51), were included for ASD screening. The predictive validity, acceptability, scale assumptions, Internal consistency, and precision were analysed. Results: The internal consistency was high (α = 0.93), and the standard error was adequate (1.13 [95% CI, -1.08 a 3.34]). The mean scores of the Autism module were higher in patients diagnosed with ASD and mental disability compared to the rest of the patients (P < 0.001). The area under the curve was 0.96 for the ASD group. Conclusion: The autism domain of the A-TAC scale seems to be a reliable, valid and precise tool for ASD screening in the Spanish school population (AU)

[Psychometric attributes of the Spanish version of A-TAC screening scale for autism spectrum disorders]. / Atributos psicométricos de la versión española de la escala de cribado A-TAC para trastornos del espectro autista.

BACKGROUND: As there are no biological markers for Autism Spectrum Disorders (ASD), screening must focus on behaviour and the presence of a markedly abnormal development or a deficiency in verbal and non-verbal social interaction and communication. OBJECTIVE: To evaluate the psychometric attributes of a Spanish version of the autism domain of the Autism-Tics, AD/HD and other Comorbidities Inventory (A-TAC) scale for ASD screening. MATERIAL AND METHODS: A total of 140 subjects (43% male, 57% female) aged 6-16, with ASD (n=15), Mental Retardation (n=40), Psychiatric Illness (n=22), Tics (n=12) and controls (n=51), were included for ASD screening. The predictive validity, acceptability, scale assumptions, internal consistency, and precision were analysed. RESULTS: The internal consistency was high (α=0.93), and the standard error was adequate (1.13 [95% CI, -1.08 a 3.34]). The mean scores of the Autism module were higher in patients diagnosed with ASD and mental disability compared to the rest of the patients (P<.001). The area under the curve was 0.96 for the ASD group. CONCLUSION: The autism domain of the A-TAC scale seems to be a reliable, valid and precise tool for ASD screening in the Spanish school population.

[Agreement between pneumotachograph and PiKo-1 measurements of PEF and FEV1]. / Estudio de la concordancia de 2 aparatos para la medida del PEF y FEV1: neumotacógrafo y PiKo-1.

OBJECTIVE: To assess how well values for peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV1) agree when measured with the PiKo-1 device and with a conventional pneumotachograph. PATIENTS AND METHODS: This randomized, single-blind study included 40 patients who attended the clinic for lung function testing. The 2 measurement devices were the Masterlab pneumotachograph and the PiKo-1. A correction factor estimated by the manufacturer was applied to the measurements taken with the PiKo-1. RESULTS: The values obtained with the 2 devices differed by a mean of 5.8218 L/min for PEF (95% confidence interval [CI], -9.4809 to 21.1387) and 0.001 L for FEV1 (95% CI, -0.0616 to 0.0636). The intraclass correlation coefficient was 0.9652 (95% CI, 0.9336-0.9819) for PEF and 0.9876 (95% CI, 0.9761-0.9936) for FEV1. CONCLUSIONS: The PiKo-1 is a simple and easy-to-use device that can be very useful for monitoring and assessing the severity of obstructive pulmonary diseases. The results must be corrected for altitude and the estimated correction factor should be applied.

Estudio de la concordancia de 2 aparatos para la medida del PEF y FEV1: neumotacógrafo y PiKo-1 / Agreement between pneumotachograph and PiKo-1 measurements of PEF and FEV1

Objetivo: Evaluar la concordancia de las mediciones del flujo espiratorio máximo (PEF) y del volumen espiratorio forzado en el primer segundo (FEV1) entre el medidor PiKo-1 y un neumotacógrafo de uso habitual. Pacientes y métodos: Se incluyó a 40 pacientes que acudieron al laboratorio de pruebas funcionales respiratorias para el estudio de su función pulmonar. El estudio se realizó de forma aleatorizada y ciega con los 2 sistemas de medida (neumotacógrafo Masterlab y PiKo-1). En las mediciones del PiKo-1 se introdujo el factor de corrección estimado por el fabricante. Resultados: Las diferencias medias obtenidas fueron para el PEF de 5,8218 (intervalo de confianza [IC] del 95%, ­9,4809 a 21,1387) y para el FEV1 de 0,001 (IC del 95%, ­0,0616 a 0,0636). El coeficiente de correlación intraclase fue de 0,9652 (IC del 95%, 0,9336-0,9819) para el PEF y de 0,9876 (IC del 95%, 0,9761-0,9936) para el FEV1. Conclusiones: El PiKo-1 es un aparato de medida sencillo y de fácil manejo que puede ser de gran utilidad para el seguimiento y la valoración de la gravedad en las enfermedades obstructivas pulmonares. Los resultados deben corregirse en función de la altitud y el factor de corrección estimado

Objective: To assess how well values for peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV1) agree when measured with the PiKo-1 device and with a conventional pneumotachograph. Patients and methods: This randomized, single-blind study included 40 patients who attended the clinic for lung function testing. The 2 measurement devices were the Masterlab pneumotachograph and the PiKo-1. A correction factor estimated by the manufacturer was applied to the measurements taken with the PiKo-1. Results: The values obtained with the 2 devices differed by a mean of 5.8218 L/min for PEF (95% confidence interval [CI], ­9.4809 to 21.1387) and 0.001 L for FEV1 (95% CI, ­0.0616 to 0.0636). The intraclass correlation coefficient was 0.9652 (95% CI, 0.9336-0.9819) for PEF and 0.9876 (95% CI, 0.9761-0.9936) for FEV1. Conclusions: The PiKo-1 is a simple and easy-to-use device that can be very useful for monitoring and assessing the severity of obstructive pulmonary diseases. The results must be corrected for altitude and the estimated correction factor should be applied

[Sleep apnea syndrome in children]. / Syndrome d'apnées hypopnées du sommeil chez l'enfant.

Obstructive sleep apnea is characterized by prolonged, generally partial, upper airways obstruction associated with hypoxemia and/or hypercapnia. Main etiological factors include hypertrophy of the tonsils and adenoids. Polysomnography is the gold standard for diagnosis. Diagnosis of obstructive sleep apnea must be established early in order to prevent complications. Adenotonsillectomy is an effective therapy.

[Variations in the prevalence and patient profile of white-coat syndrome, according to its definition using self-measurement of blood pressure at home]. / Variaciones de la prevalencia y el perfil del paciente con fenómeno de bata blanca, según su definición con automedida de presión arterial domiciliaria (AMPA).

OBJECTIVE: To calculate the prevalence of white-coat syndrome (WCS) in patients with hypertension, comparing the two most common definitions and their effect on the profile of the patient with WCS. DESIGN: Cross-sectional, descriptive study.Setting. Urban health centre.Patients. Hypertense patients selected by simple randomised sampling from among those included in the hypertension programme. MEASUREMENTS: Clinical blood pressure (CBP) from the previous year was collected. Home blood pressure (HBP) was measured by the patient with an electronic sphygmomanometer. Age, sex, further tests (analysis and electrocardiogram) and other clinical features were also recorded. WCS was defined as when CBP was above/equal to 140/90 mmHg and HBP was under 135/85 mmHg or when the difference between CBP and HBP was more than/equal to 20 mmHg systolic and/or 10 mmHg diastolic pressure. RESULTS: In 154 hypertense patients (60.4% women) between 38 and 92 years old, mean CBP (141.1/85.3) was higher than mean HBP (136.8/79.8). WCS prevalence varied (p = 0.001), depending on the definition used (20.1% and 36.4%). The systolic and diastolic mean CBP of the last year were higher in those patients with WCS (p < 0.001 for diastolic pressure). The profile of hypertense patients with WCS varied according to the definition used. CONCLUSIONS: WCS is common in hypertense patients treated in Primary Care and may condition an inadequate assessment of the degree of blood pressure monitoring. As the way of defining WCS conditions its prevalence, its profile and clinical decision-taking, it is essential to agree a uniform definition for practical use.

[The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon]. / Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al tratamiento con interferón.

BACKGROUND: Although many studies have been implemented in order to determine the pre-treatment factors that can predict patients' response to interferon (IFN) therapy, it is not yet clear whether characteristic histologic abnormalities in chronic hepatitis C can predict such response. AIMS: The aim of this study were to evaluate, in patients with chronic hepatitis C, (i) the predictive value of histologic lesions for the sustained response to IFN therapy (ii) other pre-treatment (epidemiological and analytical) factors known to be predictive of response. PATIENTS AND METHODS: Sustained response was retrospectively evaluated in two hundred one patients who had been treated with IFN for at least 3 months in four different hospitals from Castilla y León. The following histological parameters were studied as predictors of response: histological diagnosis, Knodell index, grading and stage, characteristic histologic lesions of HCV infection. Epidemiological and analytical parameters were also evaluated. RESULTS: The rate of patient's sustained response to IFN treatment was 16%. None of the histological parameters was useful to predict this response. By univariate analysis, age, disease evolution time, mode of viral transmission, GGT, ferritin and viral genotype were associated with a sustained response. The most powerful, and only independent predictive factor, however, was the genotype (the response odds ratio was 8.6). CONCLUSIONS: Histological parameters do not predict the response to IFN treatment. Other factors (mainly the viral genotype) are associated with a higher response percentage, although no one is useful to decide which patients are going to respond.

Variaciones de la prevalencia y el perfil del paciente con fenómeno de bata blanca, según su definición con automedida de presión arterial domiciliaria (ampa) / Variations in the prevalence and patient profile of white-coat syndrome, according to its definition using self-measurement of blood pressure at home

Objetivo. Estimar la prevalencia del fenómeno de bata blanca (FBB) en hipertensos tratados, comparando las dos definiciones más empleadas y su influencia en el perfil del paciente con FBB. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de salud urbano. Pacientes. Hipertensos seleccionados mediante muestreo aleatorio simple entre los incluidos en el programa de hipertensión arterial. Mediciones. Se recogieron las tensiones arteriales en la clínica (TAC) del último año y se midieron por el paciente las tensiones arteriales domiciliarias (TADo) con esfigmomanómetro electrónico, además de edad, sexo, pruebas complementarias (analítica y electrocardiograma) y otras características clínicas. Se definió FBB cuando la TAC era 140/90 mmHg y la TADo < 135/85 mmHg o cuando la diferencia entre TAC y TADo era 20 mmHg de sistólica y/o 10 mmHg de diastólica. Resultados. En 154 pacientes hipertensos (60,4 por ciento mujeres) de 38-92 años, la TAC media (141,1/85,3) fue superior a la TADo media (136,8/79,8). La prevalencia de FBB fue diferente (p = 0,001) según la definición empleada (20,1 por ciento y 36,4 por ciento). Las TAC sistólicas y diastólicas medias del último año fueron superiores en los pacientes que presentaban FBB (p < 0,001 para la diastólica). El perfil del hipertenso con FBB variaba según la definición empleada. Conclusiones. El FBB es frecuente en hipertensos tratados en atención primaria y puede condicionar una inadecuada valoración del grado de control de la TA. La manera de definirlo condiciona su prevalencia, perfil y toma de decisiones clínicas, por lo que consensuar una definición uniforme parece imprescindible para su aplicación práctica (AU)

Las lesiones anátomo-patológicas de la hepatitis crónica C como factores predictivos de respuesta mantenida al trata miento con interferón / The histological lesions of chronic hepatitis C as predicting factors of sustained response to the treatment with interferon

Introducción: Aunque se han realizado múltiples estudios para conocer los factores pre-tratamiento que pueden predecir la respuesta al tratamiento con interferón (IFN), se desconoce si las lesiones histológicas características de la hepatitis crónica C (HCC) sirven para predecir dicha respuesta. Objetivos: Valorar si los parámetros histológicos pueden predecir la respuesta mantenida al tratamiento con IFN en los pacientes con HCC, y estudiar otros parámetros (epidemiológicos y analíticos) ya descritos como factores predictivos de respuesta. Métodos: Se estudiaron de forma retrospectiva 201 pacientes, tratados con IFN durante al menos 3 meses en cuatro hospitales de Castilla y León. La variable dependiente analizada fue la respuesta mantenida al tratamiento. Como factores predictivos de respuesta se estudiaron las siguientes variables histológicas: diagnóstico histológico, índice de Knodell total y por apartados, grado y estadio, y lesiones características de la HCC. Además, se analizaron parámetros epidemiológicos y analíticos. Resultados: El 16 por ciento de los pacientes presentó una respuesta mantenida. Ninguno de los parámetros histológicos sirvió para predecir dicha respuesta. Demostraron ser factores predictivos en el análisis bivariante la edad, el tiempo de evolución de la HCC, la vía de transmisión, la GGT, la ferritina y el genotipo viral. El factor predictivo más importante fue el genotipo viral, y el único asociado independientemente a la respuesta mantenida ("odds ratio" de respuesta al tratamiento de 8,6). Conclusiones: Los parámetros histológicos no predicen la respuesta al tratamiento con IFN. Otros factores, fundamentalmente el genotipo viral, se asocian a un mayor porcentaje de respuestas, aunque ninguno sirve para decidir con exactitud qué pacientes responderán. (AU)

[Situation in Spain of the diagnostic resources and of the treatment with continuous positive pressure respiration in sleep obstructive apnea-hypopnea syndrome]. / Situación en España de los recursos diagnósticos y de los tratamientos con presión positiva continua sobre la vía aérea, en el síndrome de apneas-hipopneas obstructivas del sueño.

Sleep apnea-hypopnea syndrome (SAHS) is a major health problem whose estimated prevalence is 2 to 4% of the population. The Respiratory Insufficiency and Sleep Disorders Task Force estimated in 1995 that over one million people suffer SAHS with clinical repercussions in Spain while the number of patients receiving treatment was 8,000; diagnostic resources were not widely available. The aim of this study was to analyze the current situation in Spain. A survey carried out nation-wide in the period from 1995 to 1997 revealed that approximately 28,000 individuals were receiving nighttime support ventilation, signifying a prevalence of 72 per 100,000 inhabitants for this type of treatment. This situation has come about in a context of insufficient availability of diagnostic tools, with nocturnal oxygen levels having been established for some 37% of patients. We conclude that a broad plan to diagnose and treat patients with SAHS is required. The plan should include: a) greater availability of diagnostic tools; b) protocols for coordination; c) programs for continuous training and updating of knowledge of this disease, and d) revision of systems for financing support ventilation.

Situación en España de los recursos diagnósticos y de los tratamientos con presión positiva continua sobre la vía aérea, en el síndrome de apneas-hipopneas obstructivas del sueño / Continuous positive airway pressure for obstructive sleep apnea syndrome: the current state of diagnostic resources and therapy in Spain

El síndrome de apneas-hipopneas del sueño (SAHS) constituye un problema de salud de primera magnitud con una prevalencia estimada del 2-4 por ciento de la población. En 1995, el grupo de trabajo del Área de Insuficiencia Respiratoria y Trastornos del Sueño estimó que en España había más de un millón de personas que sufrían de SAHS, con repercusión clínica, mientras que el número de pacientes en tratamiento entonces ascendía a 8.000, y se constataba una baja disponibilidad de métodos diagnósticos. El objetivo de este estudio es analizar la situación actual en nuestro país y para ello en el período 1995-1997 y mediante cuestionario, llevado a cabo en todo el territorio español, hemos constatado que a finales de 1997 aproximadamente 28.000 personas realizan tratamiento con soporte ventilatorio nocturno, lo que implica una prevalencia de estos tratamientos de 72/100.000 habitantes y todo ello con un nivel insuficiente en cuanto a recursos diagnósticos, que son establecidos hasta en un 37 por ciento de los casos con registro oximétrico nocturno. Concluimos que es precisa la elaboración de un plan global para el diagnóstico y tratamiento de pacientes con SAHS que incluya: a) incremento de recursos diagnósticos; b) protocolos de coordinación; c) programas de formación continuada en esta disciplina, y d) replanteamiento de las fórmulas de financiación de los sistemas de soporte ventilatorio. (AU)

[Validation of half-night polysomnography for sleep apnea/hypoapnea syndrome]. / Validación de estudios polisomnográficos de mitad de la noche en el síndrome de apneas/hipoapneas durante el sueño.

UNLABELLED: A diagnosis of sleep apnea/hypopnea syndrome (SAHS) is based on clinical signs and nighttime polysomnograms. Brief polysomnography has been proposed as an alternative to all-night recording. OBJECTIVES: The aim of this study was to determine whether a polysomnograms obtained during the first half of the night is sufficient for establishing a diagnosis of SAHS and to determine the correlation between polysomnographic variables recorded during the first four hours (half the study time) with those recorded over the full eight hours (full study time), as well as to determine diagnostic agreement. DESIGN: Thirty-five patients suspected of having SAHS were studied prospectively. Baseline polysomnograms were scored blindly by two independent observers following standard methods. A diagnosis of SAHS was made according to guidelines of the Spanish Society of Pneumology and Chest Surgery. During the first half of the night and up to the end of each recording period we gathered neurophysiological and respiratory variables and diagnostic impressions. RESULTS: The correlation between variables (sleep stage, overall AHI, REM-AHI, non-REM-AHI and sleep efficiency) recorded in the first half of the night and throughout the night was significant (p < 0.05) by both Pearson's correlation coefficient (r) and by the intraclass correlation coefficient (ICC). In 33 of 35 patients (94.3%) diagnostic agreement was achieved (95% CI 80.84-99.30); when SAHS was severe, agreement was 100%. CONCLUSION: Based on these results, we conclude that for patients with a diagnosis of severe SAHS during the first half of the night, data recorded during the second half can be considered supplementary.

Validación de estudios polisomnográficos de mitad de la noche en el síndrome de apneas/hipoapneas durante el sueño / Validation of half-night polysomnograms for sleep apnea syndrome

El diagnóstico del síndrome de apneas/hipoapneas del sueño (SAHS), se establece en función de manifestaciones clínicas y registros polisomnográficos (PSG) nocturnos. Como alternativa a la PSG nocturna completa, se han propuesto estudios nocturnos abreviados. Objetivos: Determinar si la corrección de la PSG de la primera mitad de la noche es suficiente para establecer el diagnóstico de SAHS y analizar la correlación existente entre las variables polisomnográficas de los registros de 4 h (mitad del estudio) frente a los de ocho horas de duración (estudio completo), así como determinar la coincidencia diagnóstica. Diseño: Se estudian de forma prospectiva 35 pacientes con sospecha clínica de SAHS, a los que se realiza un estudio polisomnográfico basal nocturno, corregido de forma ciega por dos observadores diferentes, según los métodos estándar. El diagnóstico de SAHS, se realiza según la normativa de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR). En la primera mitad y al final del estudio PSG se recogen variables neurofisiológicas, respiratorias y la impresión diagnóstica. Resultados: La correlación encontrada entre las diferentes variables consideradas (estadios de sueño, índice de apnea/hipoapnea [IAH] global, IAH REM, IAH no REM y eficiencia del sueño) entre la mitad (MN) y el estudio PSG completo (TN) es significativa para un valor de p < 0,05, tanto al aplicar el coeficiente de correlación de Pearson (r) como al aplicar el coeficiente de correlación intraclase (CCI). La coincidencia diagnóstica se produjo en 33 de los 35 pacientes estudiados (94,3 por ciento; intervalo de confianza [IC] del 95 por ciento: 80,84-99,30), siendo del 100 por ciento en el caso de los SAHS severos. Conclusión: Sobre la base de los resultados obtenidos, concluimos que los pacientes con diagnóstico de SAHS severo en la primera mitad de la noche son subsidiarios de estudios de titulación en la segunda mitad de la noche. (AU)

[The stability of the microalbuminuria numbers in relation to their reading time and mode of preservation]. / Estabilidad de las cifras de microalbuminuria en relación con el tiempo de lectura y el modo de conservación.

OBJECTIVE: To evaluate the stability of microalbuminuria figures in urine samples of diabetic patients, in terms of how the samples are kept, and the time between taking and reading. DESIGN: Descriptive, prospective and observational study. SETTING: Primary care. Teaching health centre, Burgos. PATIENTS: 40 type-2 diabetics had their urinary excretion of albumin measured in 91 first-in-the-morning urine samples with Micral Test II reactive strips. INTERVENTIONS: Samples were analysed the day of their collection, then protected from light and kept at +4 degrees C, with further readings at 24, 48 and 72 hours and at 7, 14, 21 and 28 days after collection. MEASUREMENTS AND MAIN RESULTS: 49 (53.84%) of the 91 samples taken did not vary over the 28 days of the study. In the first three days, there were 64 with unvaried measurements (70.2%). Friedman's test showed p = 0.905. > 93% of samples positive at the beginning remained positive all the time; > 83% of samples negative at the beginning remained negative. Concordance observed was > 90%; kappa index > 80%. CONCLUSIONS: Collection of first urine samples in the morning, stored at +4 degrees C in a fridge and protected from light, did not significantly alter the result of the reading for 4 weeks. Such samples are useful in order to aid study of the albumin excretion rate using Micral Test II reactive strips.

[Efficacy of demand of positive airway pressure therapy for treating obstructive sleep apnea syndrome]. / Eficacia de la presión positiva a demanda en el tratamiento del síndrome de apnea obstructiva del sueño.

UNLABELLED: The treatment of choice for obstructive sleep apnea syndrome (OSAS) is nasal continuous positive airway pressure (nCPAP). The precise level of pressure is adjusted by polysomnography. Devices to deliver pressure on demand have recently been designed to adapt the level of pressure to each respiratory cycle according to flow modification. OBJECTIVE: To compare the manual titering nCPAP system with that of demand continuous positive airway pressure (nDPAP) in patients diagnosed of OSAS. PATIENTS AND METHODS: Eighteen consecutive patients whose OSAS was diagnosed by conventional polysomnography were enrolled with apnea-hypopnea indexes over 10/hour (AHI > 10) and clinical symptoms of daytime drowsiness and/or cardiovascular risk factors. Titering polysomnographs were performed for all patients with nCPAP and with nDPAP and analyzed blindly. RESULTS: No significant differences between nCPAP and nDPAP were found in neurophysiological variables analyzed (sleep architecture, arousals, sleep efficiency) or in respiratory variables (AHI, oxygen saturation) with the exception of minimum SatO2 during REM sleep, which was significantly better with nCPAP (p < 0.03). Mean end pressure with nCPAP and mean pressure with nDPAP were similar; it is also worth noting that mean pressure was lower with nDPAP than with titered nCPAP pressure a mean 65.7 +/- 22% of the time. CONCLUSION: Automatic nDPAP is as effective as titered nCPAP for treating patients with OSAS.

The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander.

BACKGROUND AND METHODS: Drowsiness and lack of concentration may contribute to traffic accidents. We conducted a case-control study of the relation between sleep apnea and the risk of traffic accidents. The case patients were 102 drivers who received emergency treatment at hospitals in Burgos or Santander, Spain, after highway traffic accidents between April and December 1995. The controls were 152 patients randomly selected from primary care centers in the same cities and matched with the case patients for age and sex. Respiratory polygraphy was used to screen the patients for sleep apnea at home, and conventional polysomnography was used to confirm the diagnosis. The apnea-hypopnea index (the total number of episodes of apnea and hypopnea divided by the number of hours of sleep) was calculated for each participant. RESULTS: The mean age of the participants was 44 years; 77 percent were men. As compared with those without sleep apnea, patients with an apnea-hypopnea index of 10 or higher had an odds ratio of 6.3 (95 percent confidence interval, 2.4 to 16.2) for having a traffic accident. This relation remained significant after adjustment for potential confounders, such as alcohol consumption, visual-refraction disorders, body-mass index, years of driving, age, history with respect to traffic accidents, use of medications causing drowsiness, and sleep schedule. Among subjects with an apnea-hypopnea index of 10 or more, the risk of an accident was higher among those who had consumed alcohol on the day of the accident than among those who had not. CONCLUSIONS: There is a strong association between sleep apnea, as measured by the apnea-hypopnea index, and the risk of traffic accidents.