Expresión de los factores de transcripción sensibles a la hipoxia, de la respuesta inflamatoria y del estrés oxidativo a nivel muscular en tres modelos clínicos de hipoxemia / Expression of transcription factors sensitive to hypoxia, of the inflammatory response and oxidative stress to muscle level in three clinical models of hypoxemia

OBJETIVO: Comparar la expresión de marcadores de respuesta a hipoxia, inflamatorios y de estrés oxidativo en biopsia muscular de grupos de pacientes con hipoxia crónica continua, crónica intermitente y ambas combinadas. Evaluar el estado de la musculatura periférica y compararla entre grupos. METODOLOGÍA: Incluimos varones mayores de 18 años, diagnosticados de EPOC, Apnea Obstructiva del Sueño (AOS) o AOS-EPOC, a los que se realizó biopsia muscular del cuádriceps. Los biomarcadores seleccionados para su estudio en músculo fueron factores de transcripción asociados a la hipoxia, como el factor inducible por hipoxia HIF-1, HIF-2 y el factor nuclear. También biomarcadores inflamatorios como factor de necrosis tumoral-α, interkeukina 6 y 8, factor de crecimiento endotelial vascular y proteína de adhesión celular vascular 1 (VCAM-1), así como biomarcadores de estrés oxidativo, como superóxidodismutasa (SOD) y actividad catalasa. Además se realizó evaluación de la función muscular en los tres grupos. RESULTADOS: Reclutamos 29 sujetos: 4 con EPOC, 12 con AOS y 13 EPOC-AOS. En el músculo, encontramos diferencias entre los grupos de estudio en VCAM-1 (casos de EPOC que expresan 2,1 veces más que AOS y 1,16 veces más que EPOC-AOS) y SOD (EPOC-AOS que expresan 3,48 veces más que EPOC, y AOS 3,02 veces más que EPOC). CONCLUSIONES: La expresión de biomarcadores estudiados es de intensidad similar en los tres grupos de pacientes referidos, con pocas excepciones.La fuerza muscular periférica y el porcentaje de masa libre de grasa es significativamente menor en los pacientes con EPOC que en los pacientes con AOS. (AU)

OBJECTIVE: Compare the expression of markers of response to hypoxia, inflammation and oxidative stress in biopsy muscle of groups of patients with continuous chronic hypoxia, intermittent chronic and both combined. Evaluate the state of the peripheral musculature and compare it between groups. METHODOLOGY: We included males older than 18 years, diagnosed of COPD, Obstructive Sleep Apnea (OSA) or OSA-COPD, to quadriceps muscle biopsy was performed. biomarkers selected for study in muscle were factors of transcription associated with hypoxia, such as the factor inducible by hypoxia HIF-1, HIF-2 and nuclear factor. Also biomarkers Inflammatory agents such as tumor necrosis factor-α, interkeukin 6, and 8, vascular endothelial growth factor and adhesion protein vascular cell 1 (VCAM-1), as well as stress biomarkers oxidative, such as superoxide dismutase (SOD) and catalase activity. In addition, evaluation of muscle function was performed in the three groups. RESULTS: We recruited 29 subjects: 4 with COPD, 12 with OSA and 13 COPD-OSA. In muscle, we found differences between the study groups in VCAM-1 (COPD cases expressing 2.1-fold more than OSA and 1.16 times more than COPD-OSA) and SOD (COPD-OSA than express 3.48 times more than COPD, and OSA 3.02 times more than COPD). CONCLUSIONS: The expression of studied biomarkers is of similar intensity in the three groups of referred patients, with few exceptions. Peripheral muscle strength and percentage of fat-free mass is significantly lower in patients with COPD than in patients with OSA. (AU)

Síndrome de apneas-hipopneas del sueño: ¿hay diferencias en las formas de presentación y características clínicas según la edad de los pacientes? / OSA: are there differences in the forms of presentation and clinical characteristics according to the age of the patients?

Antecedentes y objetivo. El síndrome de apneas-hipopneas del sueño (SAHS) puede tener unas características clínicas propias dependiendo de la edad y es importante profundizar en el conocimiento de estas para afrontar el creciente aumento en la actividad asistencial en algunos grupos de edad. Materiales y métodos. Estudio observacional transversal retrospectivo, en una población de 2.087 pacientes remitidos a una unidad especializada en trastornos respiratorios del sueño por sospecha de SAHS, para analizar las características clínicas, antropométricas y de los estudios de sueño; dividiendo la población en tres grupos etarios: jóvenes, edad media y ancianos. Resultados. Hemos encontrado un predominio superior de hombres en los tres grupos, con un porcentaje de mujeres más elevado a medida que aumenta la edad. Salvo la dislipemia, el resto de comorbilidades encontradas han sido superiores en los ancianos. Respecto a los síntomas de SAHS más relevantes no encontramos diferencias significativas en los tres grupos. El índice de masa corporal (IMC) no difiere en los tres grupos y, en el grupo de mediana edad, este parámetro se correlaciona con un perfil glucídico y lipídico más desfavorable, cosa que no sucede en los ancianos. A diferencia del IMC, la cintura y el índice cintura-cadera (ICC) aumentan a medida que lo hace la edad. En los pacientes jóvenes, pero no en los ancianos, las alteraciones oximétricas propias del SAHS se correlacionan con marcadores bioquímicos de riesgo metabólico y cardiovascular

Background and objectives. Obstructive sleep apnea (OSA) can have its own clinical characteristics depending on age and it is important to improve our knowledge of these characteristics will allow us to cope with the increase in health care of some age groups. Material and Methods. Retrospective cross-sectional observational study in 2.087 patients referred to a Unit specialized in Sleep Respiratory Disorders due to suspicion of OSA in order to analyze the clinical, anthropometric and sleep characteristics, dividing the population into three age groups: young people, middle age and elderly. Results. We found a higher percentage of men than women in all the groups. The percentage of women increases with the age. All comorbidities, except dyslipemia, were more predominant in the elderliest group. Regarding the most relevant symptoms of OSA, we did not find significant differences in the three groups. The body mass index (BMI) does not differ in the three groups and, in the middle age group, this parameter correlates with a worse glucidic and lipid profile, something that does not happen in the elderly group. Unlike BMI, the waist and waist-hip ratio (WHR) increase as age does. In younger patients, but not in the elderly, the oximetric alterations characteristic of OSA are correlated with biochemical markers of metabolic and cardiovascular risk. Conclusions. There are some differential aspects in the clinical presentation of OSA and its consequences, depending on the age of the patients

Disfunción endotelial medida con flujimetría láser-doppler en pacientes con Síndrome de apneas-hipopneas del sueño. Efecto del tratamiento con presión positiva continua en la vía aérea / Endothelial dysfunction measured with a Laser-Doppler flowmetry in patients with sleep apnea-hypopnea syndrome. The effecto ftreatment with continuous positive airway pressure

INTRODUCCIÓN: El SAHS se relaciona con el desarrollo de enfermedades cardiovasculares, con un aumento de la mortalidad de los pacientes que lo padecen. Dentro del espectro de la afectación cardiovascular, cada día se reconoce como más importante la disfunción endotelial. MATERIAL Y MÉTODOS: Estudio prospectivo de pacientes diagnosticados de SAHS mediante poligrafía respiratoria con indicación de CPAP. La función endotelial se ha valorado mediante la técnica no invasiva de flujimetría láser-doppler, realizada de manera basal y tras 3 meses de tratamiento con CPAP. RESULTADOS: Hemos observado una correlación significativa entre los parámetros oximétricos de la poligrafía respiratoria y algunos parámetros de la flujimetría basal. Además, hemos encontrado un aumento significativo en el valor del área bajo la curva y una disminución del valor de la pendiente de la flujimetría láser doppler (que indica mejoría de la función endotelial) tras la realización del tratamiento con CPAP durante 3 meses

INTRODUCTION: Sleep apnea-hypopnea syndrome (SAHS) is linked to the development of cardiovascular diseases, with increased mortality among these patients. Within the range of cardiovascular affections, the importance of endothelial dysfunction is evermore recognized. MATERIAL AND METHODS: Prospective studies in patients with SAHS using respiratory polygraph with continuous positive airway pressure (CPAP). Endothelial function has been assessed using non-invasive Laser-Doppler Flowmetry, both basal and after 3 months of treatment with CPAP. RESULTS: A significant correlation was observed between the respiratory polygraph oximetry parameters and certain basal flowmeter parameters. Moreover, a significant increase in the value of the area under the curve(AUC) and a decrease in the slope of the Laser-Doppler flowmetry was seen (thus indicating an improvement of endothelial function) after a 3-month treatment with CPAP

Gamma glutamyl transferase and oxidative stress in obstructive sleep apnea: a study in 1744 patients.

OBJECTIVE: We analyze a large population of patients to determine whether gamma glutamyl transferase (GGT) levels are increased in sleep apnea-hypopnea syndrome (OSA) and whether these levels are related to clinical characteristics or polygraphic indexes. METHODS: A cross-sectional study in a population of 1744 patients referred for OSA suspicion was conducted. The following variables were determined: glucose, cholesterol, triglycerides, aspartate aminotransferase (GOT), alanine aminotransferase (GPT), GGT, body mass index, waist-hip ratio (WHR), and overnight sleep study. RESULTS: The 483 patients with GGT ≥40 IU/l were younger and more obese, and had a pattern of more centrally distributed fat than the 1261 with GGT <40 IU/l. Patients with high levels of GGT also consumed more alcohol, had a poorer biochemical profile, and had more respiratory and oximetric alterations during sleep. GGT levels were significantly correlated with AHI, DI, and CT90. In the binary regression test, WHR, glucose, cholesterol, triglycerides, and grams of alcohol consumed per day predicted GGT levels ≥40 IU/l, while none of the polygraphic variables had predictive value. CONCLUSIONS: High GGT levels were associated with the severity of OSA. However, this relationship seems to be due to the coexistence of other associated factors, mainly central obesity, rather than to the respiratory disorders found in this disease.

Protocolo de colaboración entre una unidad especializada en Trastornos Respiratorios del Sueño y Atención Primaria en la detección y derivación de pacientes con sospecha de Síndrome de apneas-hipopneas del sueño / Collaboration protocol between units specialized in Respiratory Sleep Disorders and Primary Care for the detection and referral of patients with suspected sleep apneahypoapnea syndrome

El Síndrome de apnea-hipopnea durante el sueño (SAHS) constituye un problema de salud infradiagnosticado, actualmente manejado de forma casi exclusiva en las Unidades de Trastornos Respiratorios del Sueño (UTRS). Resulta necesaria una mayor implicación del médico de Atención Primaria (MAP) en la sospecha clínica inicial, para optimizar la derivación de pacientes. Objetivo: Evaluar la aplicabilidad de un programa de colaboración entre una UTRS y los Centros de Salud (CS) para establecer protocolos específicos que mejoren la derivación de pacientes con sospecha de SAHS. Metodología: Se han visitado 20 CS del área sanitaria del Hospital Virgen del Rocío, en los que se han presentado protocolos de detección activa de casos de SAHS, así como de derivación a la UTRS para establecer la prioridad de la cita. Previamente se eligieron dos CS que actuaron como centros piloto y tras un periodo de 3 meses se contabilizaron los pacientes que fueron derivados a la UTRS con los protocolos propuestos, y se analizó si la información incluida permitía establecer la prioridad real de la cita. Resultados: Durante los 3 meses de prueba, se enviaron a la UTRS desde los CS piloto 97 pacientes por sospecha de SAHS (69% con el protocolo específico y en 10 casos se pudo clasificar la derivación como preferente).Conclusión: La mayoría de las derivaciones realizadas desde Atención Primaria (AP) se han llevado a cabo siguiendo un protocolo que permite optimizar la derivación de pacientes. Es posible mejorar la derivación de pacientes mediante programas de colaboración entre las UTRS y los MAP (AU)

Introduction: Sleep apnea-hypopnea syndrome (SAHS) is an underdiagnosed health problem, now handled almost exclusively in specialized Units of Sleep-Related Breathing Disorders (USRBD). There is a need for a wider involvement of Primary Care Physicians (PCP) in the initial clinical suspicion in order to optimize patient referral. Objective: To evaluate the applicability of a collaborative program between USRBD and Primary Care Centres (PCC) aiming at establishing specific protocols to improve the referral of patients with suspected SAHS. Methodology: We have visited 20 PCCs at Virgen del Rocío Hospital Health Area, in which protocols for active detection of cases of SAHS, as well as referral to the USBRD to set the priority of the event were presented. PCC previously chose two sites of them who acted as pilot sites during 3 months. After this pilot period the number of patients who were referred to the USRBD with the proposed protocols were analyzed together with the information that allowed them to establish the real priority of the case. Results: During the 3 months trial, there were 97 patients sent to the USRBD unit with suspected SAHS (69% with the specific protocol and in 10 cases could be classified as preferential referral).Conclusion: Most of the referrals made from the PCC were carried out following a protocol optimizing patient referral. It is possible to improve the referral of patients through programs of cooperation between the USRBD and the PCC (AU)

Early treatment of obstructive apnoea and stroke outcome: a randomised controlled trial.

The aim of the present study was to assess the impact of nasal continuous positive airway pressure (nCPAP) in ischaemic stroke patients followed for 2 yrs. Stroke patients with an apnoea-hypopnoea index ≥ 20 events·h⁻¹ were randomised to early nCPAP (n = 71; 3-6 days after stroke onset) or conventional treatment (n = 69). The Barthel Index, Canadian Scale, Rankin Scale and Short Form-36 were measured at baseline, and at 1, 3, 12 and 24 months. The percentage of patients with neurological improvement 1 month after stroke was significantly higher in the nCPAP group (Rankin scale 90.9 versus 56.3% (p < 0.01); Canadian scale 88.2 versus 72.7% (p < 0.05)). The mean time until the appearance of cardiovascular events was longer in the nCPAP group (14.9 versus 7.9 months; p = 0.044), although cardiovascular event-free survival after 24 months was similar in both groups. The cardiovascular mortality rate was 0% in the nCPAP group and 4.3% in the control group (p = 0.161). Early use of nCPAP seems to accelerate neurological recovery and to delay the appearance of cardiovascular events, although an improvement in patients' survival or quality of life was not shown.

Clinical and polygraphic evolution of sleep-related breathing disorders in adolescents.

It has been suggested that sleep-related breathing disorders (SRBD) involve a continuum that develops over the course of life. If modifiable factors could be identified, the progression of SRBD could perhaps be addressed early in life. Although some studies have looked at the evolution of SRBD in pre-pubertal children, very few studies obtained data in adolescents. Anthropometric, clinical and polygraphic variables were collected during a 4-yr follow-up study among 148 normal adolescents after initial cross-sectional analysis. From a total of 267 adolescents studied at baseline (mean+/-sd age 14.3+/-2.1 yrs), 148 (55.4%) were followed up for 4 yrs. During follow-up, there were no significant changes in snoring and polygraphic parameters. However, a tendency toward weight gain with centrally distributed fat was observed. Habitual snorers had a significantly higher body mass index and more centrally distributed fat than nonsnorers. Males had a higher snoring prevalence and a higher number of respiratory events than females. Snoring at baseline, male sex and poor academic performance were significant predictors of snoring at follow-up. Snoring tends to persist during adolescence and male sex acts as a risk factor. A relationship between snoring and academic performance was observed. These findings may have implications for long-term management of sleep-related breathing disorders.

beta3-Adrenergic receptor Trp64Arg polymorphism and increased body mass index in sleep apnoea.

Obesity is an important risk factor for obstructive sleep apnoea syndrome (OSAS), insulin resistance and cardiovascular disease. The substitution of tryptophan 64 with arginine (Trp64Arg) polymorphism (Arg variant) of the beta(3)-adrenergic receptor (ADRB3) has been associated with obesity. In this study, the prevalence of the Trp64Arg ADRB3 polymorphism in a large group of patients with OSAS and its association with body mass index (BMI), insulin resistance and hypertension were evaluated. ADRB3 genotype was determined in 387 patients with OSAS and 137 healthy subjects recruited from three Spanish tertiary hospitals. The distributions of the ADRB3 genotypes were similar in OSAS and controls, and, in a multivariate model, the risk of OSAS was not associated with the presence of the Arg variant of the ADRB3 gene. However, BMI was higher in those patients with OSAS who carried this genetic variant than in those with the Trp variant. Furthermore, a linear trend for higher BMI was found in those with the Arg variant (56, 75 and 100% for Trp/Trp, Trp/Arg and Arg/Arg, respectively). Insulin resistance, blood pressures and serum levels of lipids and glucose were not associated with the presence of the Arg variant of the ADRB3 gene. The presence of the arginine 64 allele of the beta(3)-adrenergic receptor gene does not increase the risk of obstructive sleep apnoea syndrome, but is associated with the development of obesity in those patients who suffer obstructive sleep apnoea syndrome.

Evolución del ronquido tras cuatro años de seguimiento en una población de adolescentes / Evolution of snoring after four years of follow-up in a population of adolescents

Hemos realizado un estudio prospectivo con una población de 267 sujetos adolescentes, inicialmente estudiada en una primera fase transversal, para conocer la evolución del ronquido tras un periodo de seguimiento de cuatro años. En ambas fases del estudio se completó un cuestionario específico de 82 items, los cuales incluían los síntomas nocturnos y diurnos asociados a los Trastornos respiratorios del sueño. Consideramos “roncadores” a los sujetos que roncaban “algunas veces” o “a menudo”, siendo estos últimos considerados “roncadores habituales”. En esta serie, la evolución del ronquido ha tendido hacia la estabilidad, ya que la mayoría de los sujetos que no roncaban siguen sin hacerlo, y la mayoría de los roncadores habituales siguen siéndolo. Entre estos últimos hay un predominio del sexo masculino. Los roncadores refieren con más frecuencia algunos de los síntomas que se describen en el Síndrome de apneas-hipopneas de los adultos, como apneas, despertares o astenia diurna (AU)

We have made a pilot study with a population of 267 adolescents, initially in a primary transverse study, to find the evolution of snoring after a follow-up period of four years. In both phases of the study a specific questionnaire of 82 items was completed, which included the nocturnal and diurnal symptoms associated with sleep respiratory disorders. We consider “snorers” to be those subjects that were snoring “sometimes” or “often”, the latter being considered “habitual snorers”. In this series, the evolution of snoring has tended toward stability, since the majority of the subjects that were not snoring continue without doing so, and the majority of the habitual snorers continue being such. Among the above mentioned there is a predominance of the male sex. The snorers refer with more frequency to some of the symptoms that are described in the apnea-hypopnea syndrome of adults, such as apneas, waking up or diurnal astenia (AU)

Home respiratory polygraphy for diagnosis of sleep-disordered breathing in heart failure.

The present study assessed the usefulness of home cardiorespiratory polygraphy as an alternative to overnight polysomnography for the diagnosis of sleep-disordered breathing in heart failure. A total of 75 patients with chronic stable heart failure due to systolic dysfunction (left ventricular ejection fraction < or =45%) underwent polysomnography at the Virgen del Rocio Hospital and cardiorespiratory polygraphy at home. The two studies were performed in random order and within 30 days. The accuracy of polygraphical findings was determined by sensitivity and specificity obtained by area under the receiver operating characteristics (ROC) curves for apnoea-hypopnoea index (AHI) thresholds of > or =5, > or =10 and > or =15 in the polysomnography. The area under the ROC curve for AHI > or =5, > or =10 and > or =15 was 0.896, 0.907 and 0.862, respectively. The diagnostic accuracy of polygraphy compared with polysomnography ranged 78.6-84%, with sensitivities of 68.4-82.5%, and specificities of 88.6-97.8% for the different AHI thresholds. Altogether, 29 patients had an AHI > or =10 (central pattern 24, obstructive pattern 5). Sensitivity and specificity of home polygraphy for identifying the sleep-disordered breathing pattern was 100%. These data show that home cardiorespiratory polygraphy has a high sensitivity and specificity for the diagnosis of sleep-disordered breathing associated with heart failure.

Effects of sex on sleep-disordered breathing in adolescents.

This study was conducted to determine the influence of puberty on features of sleep-disordered breathing (SDB) in adolescents. The study was performed in a general population sample of 226 adolescents of both sexes (aged 11-19 yrs) recruited from the secondary school population of the city of Seville, Spain. Subjects were divided into two groups: 1) postpubertal, i.e. females who had undergone menarche and males in whom axillary hair development or peak height velocity had occurred > 1 yr before the study; and 2) peripubertal, i.e. females who had not undergone menarche and males who had not developed axillary hair nor reached peak height velocity, or subjects in whom these pubertal changes had appeared < 1 yr before the study. All subjects answered a questionnaire on SDB and underwent overnight cardiorespiratory polygraphy. There were 50 males and 40 females (mean +/- SD age 13.5 +/- 1.2 yrs) in the peripubertal group, and 54 males and 82 females (age 16.3 +/- 1.7 yrs) in the postpubertal group. Males exhibited significantly higher neck circumference/height index and waist/hip index than females in both the peripubertal and postpubertal groups. In the postpubertal group, snoring and polygraphic alterations (respiratory events and oximetric parameters) were significantly more frequent in males than in females. Postpubertal adolescents showed sex differences in clinical and polygraphic parameters that were not observed at earlier pubertal stages. These findings support the influence of sex hormones on sex differences in sleep-disordered breathing.

Sleep-related breathing disorders in adolescents aged 12 to 16 years : clinical and polygraphic findings.

STUDY OBJECTIVES: To determine the frequency, symptoms, and polygraphic features of sleep-related breathing disorders (SRBD) in adolescents aged 12 to 16 years. DESIGN: Cross-sectional study. SETTING: Randomly selected secondary schools in the city of Seville, SPAIN: PARTICIPANTS: A general population sample of adolescents (n = 101; mean [+/- SD] age, 13.2 +/- 0.8 years). INTERVENTIONS: An 82-item questionnaire regarding anthropometric data and nocturnal and daytime symptoms suggestive of SRBD was administered. Symptoms were evaluated according to a 4-point frequency scale. Snorers answered "sometimes" or "often" in the question about snoring, and nonsnorers answered "never" or "rarely." All subjects underwent an overnight cardiorespiratory polygraphy at home. RESULTS: Twenty-nine percent of the subjects were snorers. Excessive daytime sleepiness was present in 14% of subjects, and sleep apnea was present in 3%. Polygraphy showed a respiratory disturbance index > or = 10 in 18 subjects (17.8%), but concurrent symptoms highly suggestive of SRBD were found in only 2 subjects (1.9%). Snorers had higher waist-to-hip ratios and a higher frequency of witnessed apnea or labored breathing as well as higher values of respiratory events as compared with nonsnorers. However, oximetry data were similar in both groups. CONCLUSIONS: In a nonselected group of adolescents aged 12 to 16 years, the frequency of symptoms potentially associated with SRBD was similar to that reported for younger children. Snoring was associated with a higher occurrence of other nocturnal symptoms, a more central pattern of body fat distribution, and a higher respiratory disturbance index as compared with nonsnorers. Although polygraphic abnormalities were mild, two cases of probable SRBD were found with a prevalence rate of 1.9%.

Valoración mediante escal de Epworth de la somnolencia diurna en pacientes con sospecha de síndrome de apneas obstructivas durante el sueño. Diferencias entre los pacientes y sus parejas / Daytime sleepiness measured by Epworth scale in patients suspected of sleep apnea syndrome. Differences between patients and partners

La hipersomnolencia diurna es el síntoma más importante del síndrome de apneas obstructivas durante el sueño. La escala de somnolencia de Epworth proporciona una estimación subjetiva del grado de somnolencia a través de un cuestionario que consta de 8 preguntas sobre situaciones habituales de la vida diaria, en las que se debe valorar la probabilidad de dormirse en cada una de ellas. Objetivo: Intentamos averiguar si hay diferencias en la valoración de la somnolencia diurna mediante la escala de somnolencia de Epworth entre los pacientes que consultan por sospecha de síndrome de apneas obstructivas durante el sueño y sus parejas. Material y método: Se estudió a 159 pacientes consecutivos, enviados por sospecha de patología respiratoria durante el sueño. La somnolencia de los pacientes fue estimada de forma independiente por los pacientes y por sus parejas usando la escala de somnolencia de Epworth. Resultados: De los 159 pacientes, 140 eran varones y 19 mujeres. La puntuación global media de la escala de som nolencia de Epworth realizada por los pacientes era significa tivamente menor que la contestada por las parejas (10 ñ 0,37 frente a 11 ñ 0,42; p < 0,001). Sin embargo, la correlación entre ambas era estrecha (rho = 0,79). Conclusiones: Según nuestros resultados, utilizando la escala de somnolencia de Epworth, la somnolencia subjetiva medida por las parejas es superior a la medida por los propios pacientes. (AU)

[Assessment of excessive day-time sleepiness in professional drivers with suspected obstructive sleep apnea syndrome]. / Evaluación de la somnolencia diurna excesiva en conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño.

Excessive daytime sleepiness is a common symptom of obstructive sleep apnea syndrome (OSAS) and can be a cause of traffic accidents, creating a problem of particular importance for professional drivers given the associated death, disability and professional repercussions. We assessed whether the Epworth sleepiness scale (ESS), which is a subjective measure of daytime sleepiness, correlates well with multiple sleep latency (MSL) testing, which gives an objective measure of daytime sleepiness. We also compared each method with the results of polysomnography (apnea-hypopnea index, arousal index and minimum oxygen saturation). We studied 55 professional drivers suspected of OSAS. All answered the ESS questionnaire and underwent polysomnographic and MSL testing. We found a significant, though not relevant, correlation between the degree of excessive daytime sleepiness estimated by the ESS and by MSL testing (r = -0.41; p = 0.002). A significant, though weak, correlation was found between the ESS score and the arousal index (r = 0.26; p < 0.05). Our results do not clarify which method is best for measuring excessive daytime sleepiness in professional drivers suspected of OSAS.

Evaluación de la somnolencia diurna excesiva en conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño / Assessment of excessive daytime sleepiness in professional drivers suspected of obstructive sleep apnea syndrome

La somnolencia diurna excesiva es un síntoma frecuente en el síndrome de apnea obstructiva durante el sueño, y puede ser causante de accidentes de tráfico. Este aspecto tiene especial importancia en los conductores profesionales, por la morbimortalidad y repercusión laboral que puede suponer. Hemos evaluado si la escala de somnolencia de Epworth (ESE) (medida subjetiva de la somnolencia diurna) se correlaciona bien con el test de latencia múltiple del sueño (TLMS) (medida objetiva de la somnolencia diurna). Además, hemos comparado ambos métodos con algunos parámetros de la polisomnografía (PLSG) (índice de apnea-hipopnea, índice de arousals y saturación de oxígeno mínima). Hemos estudiado a 55 conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño. A todos se les aplicó la ESE y se les realizó una PLSG y un TLMS. Encontramos una correlación significativa, aunque no relevante, entre el grado de somnolencia diurna excesiva estimada mediante la ESE y la medida por el TLMS (r = -0,41; p = 0,002). Al comparar ambos métodos con la PLSG, tan sólo encontramos una correlación significativa, aunque muy débil, entre la ESE y el índice de arousals (r = 0,26; p < 0,05). Según nuestros resultados, no está claro cuál es el mejor método para medir la somnolencia diurna excesiva en conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño (AU)

[Assessment with the Epworth scale of daytime somnolence in patients with suspected obstructive apnea syndrome during sleep. Differences between patients and their partners]. / Valoración mediante escala de Epworth de la somnolencia diurna en pacientes con sospecha de síndrome de apneas obstructivas durante el sueño. Diferencias entre los pacientes y sus parejas.

UNLABELLED: Daytime sleepiness is an important symptom in obstructive sleep apnea syndrome. The Epworth sleepiness scale gives a subjective estimate of the level of sleepiness by asking the patient to estimate the probability of falling asleep during each of eight activities of daily living. OBJECTIVE: We aimed to see whether patients suspected of sleep apnea and their partners or other living companions assessed daytime sleepiness differently. MATERIAL AND METHOD: One hundred fifty-nine consecutive patients referred for suspicion of sleep respiratory disorder were studied. Patients and their partners assessed sleepiness separately using the Epworth scale. RESULTS: One hundred forty subjects were men and 19 were women. The mean global Epworth score provided by the patients was significantly lower than that of their companions (10 +/- 0.37 versus 11 +/- 0.42; p < 0.001). However, the two were closely correlated (rho = 0.79). CONCLUSION: Our results indicate that living companions' subjective Epworth scale assessment of sleepiness is greater than is that of patients themselves.

[A comparative study of patients with chronic obstructive pulmonary disease with and without obstructive sleep apnea syndrome]. / Estudio comparativo de pacientes con enfermedad pulmonar obstructiva crónica con y sin síndrome de apneas obstructivas durante el sueño.

We aimed to study whether the presence of obstructive sleep apnea syndrome (OSAS) in patients with chronic obstructive pulmonary disease (COPD) led to differences in clinical picture, gas exchange during awake and sleep states and mechanical ventilation, in comparison with patients with COPD alone. We enrolled 48 COPD patients. In 26 (54.1%), OSAS was ruled out (non-OSAS COPD group) by polysomnography, and in 22 (45.8%) associated OSAS was diagnosed (OSAS COPD group). Patients in the OSAS COPD group experienced greater daytime sleepiness and less dyspnea. Body mass index was not significantly difference. The OSAS COPD group had significantly lower daytime PaO2 (66.4 +/- 10.4 mmHg in the OSAS COPD group and 75.5 +/- 11.2 mmHg in the non-OSAS COPD group; p = 0.01); there were no differences in PaCO2.Pimax in the OSAS-COPD group was 70.6 +/- 23.8 cmH2O, a level that was significantly lower than in the non-OSAS COPD group (Pimax 90.5 +/- 26.1 cmH2O; p = 0.04). Patients in the non-OSAS COPD group experienced longer periods of REM sleep. Nighttime saturation parameters were significantly different in the group with OSAS. We conclude that patients with both OSAS and COPD experience greater oximetric changes than those without OSAS, during both sleep and awake states. The deterioration of respiratory muscle pressures in such patients may play an important role in the changes. The groups also present differences in the intensity of some symptoms, such as degree of daytime sleepiness and dyspnea.

[Surgical treatment of adenotonsillar hypertrophy in children with sleep respiratory disorders: changes in polysomnographic patterns]. / Tratamiento quirúrgico de la hipertrofia adenoamigdalar en niños con trastornos respiratorios durante el sueño: cambio en el patrón polisomnográfico.

Adenotonsillar enlargement (ATE) can cause respiratory disorders during sleep in children. The treatment of choice for ATE is adenotonsillectomy and its efficacy must be assessed based on improvement in symptoms and polysomnographic patterns. We studied 11 children (7 boys and 4 girls, age 5.5 years) whose ATE symptoms were corrected by adenotonsillectomy. Two nighttime polysomnograms (SleepLab) were recorded, one at baseline and one 6 months after adenotonsillectomy. Polysomnographic recordings were analyzed by quantifying 1) only apneic or hypopneic events lasting > or = 10 sec and 2) all respiratory events > or = 5 sec. The most common symptoms were snoring, nocturnal dyspnea and sleep apnea. Symptoms resolved after adenotonsillectomy for most patients. Obstructive events, in particular shorter apneic events (> or = 5 sec) and instances of hypopnea, decreased after surgery. We found no changes in baseline SaO2, although the minimum SaO2 improved and the number of desaturations decreased, above all those stemming from respiratory events.