[Sleep apnea syndrome in heart failure. Effect of continuous positive airway pressure]. / Síndrome de apnea del sueño en la insuficiencia cardiaca. Efecto de la presión positiva continua en la vía aérea.

INTRODUCTION: Sleep disordered breathing and heart failure are common disorders that are frequently associated in the same patients which may bring on serious consequences. OBJECTIVE: To determine the prevalence of sleep apnea syndrome (SAS) in patients with controlled heart failure and the associated prevalence of arrhythmia. In addition, we to aim to evaluate the effectiveness of continuous positive airway pressure (CPAP) treatment for OSAS on left ventricular ejection fraction (EF). MATERIAL AND METHODS: We prospectively studied 60 patients (50 men, 10 women) with heart failure due to systolic dysfunction (left ventricular EF < 45%). All subjects were classified according the NYHA functional scale and received a specific questionnaire, as well as a home respiratory polygraphy and EKG Holter. A subject was considered to have SAS if their IAH > 15, and, according to standard recommendation, patients with IAH > 30 were treated with CPAP. After 3 months of treatment, the questionnaire, respiratory polygraphy and EKG Holter were repeated. RESULTS: Age was 69.3 +/- 10.4 years and the BMI was 28.5 +/- 4.74 kg/m2. Of the total sample, 55% (33 cases) were habitual snorers. The Epworth scale scores were 7.83 +/- 4.8. The EF was 36.3 +/- 7.4%, and 36 patients were NYHA class II, 23 were class III, and one patient was class IV. A total of 38 patients had SAS (63%): 14 (36%) had central sleep apnea and 24 (64%) had obstructive sleep apnea. EF revealed no significant differences between the SAS and non-SAS groups (36.42 +/- 7.6 vs. 35.81 +/- 6.6%, respectively). The SAS group presented a higher prevalence of bradicardia than the non-SAS group (24 % vs. 9%). After CPAP treatment, there was a significant improvement in EF (9%), in cases of obstructive sleep apnea, but no significant improvement was observed in patients with central sleep apnea. CONCLUSIONS: The prevalence of SAS in patients with heart failure due to systolic dysfunction is very high. CPAP treatment improved the EF in patients with obstructive sleep apnea.

Síndrome de apnea del sueño en la insuficiencia cardiaca. Efecto de la presión positiva continua en la vía aérea / Sleep apnea syndrome in heart failure. Effect of continuous positive airway pressure

Introducción: Los trastornos respiratorios durante el sueño (TRS) y la insuficiencia cardiaca (IC) son patologías muy comunes que con frecuencia se asocian en el mismo paciente con consecuencias que pueden ser graves. Objetivo: Conocer la prevalencia de síndrome de apnea del sueño (SAS) en pacientes con IC estable, arritmias asociadas, así como evaluar el efecto del tratamiento con presión positiva continua (CPAP) del SAS sobre la fracción de eyección de ventrículo izquierdo (FE). Material y métodos: Estudiamos de forma prospectiva a 60 pacientes (50 varones y 10 mujeres) con IC debida a disfunción sistólica (fracción de eyección del ventrículo izquierdo FE < 45%). A todos los pacientes se les realizó un cuestionario específico así como poligrafía respiratoria y un Holter en su domicilio. Se consideró la presencia de SAS cuando el IAH > 15 y aquellos con IAH > 30 fueron tratados con CPAP realizando los mismos estudios anteriores, poligrafía y Holter, a los 3 meses. Resultados: La edad fue de 69,3 ± 10,4 años y el índice de masa corporal (IMC) de 28,5 ± 4,74 kg/m 2. Un 55% (33 casos) eran roncadores habituarles y la puntuación en la escala Epworth era de 7,83 ± 4,8. La FE fue de 36,3 ± 7,4%, estando 36 enfermos en clase funcional II, 23 en clase funcional III y un enfermo en clase funcional IV. Un total de 38 pacientes tenían SAS (63%): 14 (36%) de tipo central y 24 (64%) de tipo obstructivo. La FE no mostró diferencias significativas entre el grupo SAS (36,4 ± 7,6) vs. (35,8 ± 6,6%) en el no-SAS. Los pacientes con SAS presentaron más frecuentemente bradicardia sinusal con respecto a los sujetos sin SAS (24% vs. 9%). Tras tratamiento con CPAP se observa una mejoría significativa de la FE de 9%, en los casos de SAS de predominio obstructivo, no observando cambios en los pacientes con SAS de predominio central. Conclusiones: La prevalencia de síndrome de apnea del sueño en pacientes con insuficiencia cardiaca y disfunción sistólica es muy alta. El tratamiento con CPAP mejora la fracción de eyección de los sujetos con SAS de carácter obstructivo

Introduction: Sleep disordered breathing and heart failure are common disorders that are frequently associated in the same patients which may bring on serious consequences. Objective: To determine the prevalence of sleep apnea syndrome (SAS) in patients with controlled heart failure and the associated prevalence of arrhythmia. In addition, we to aim to evaluate the effectiveness of continuous positive airway pressure (CPAP) treatment for OSAS on left ventricular ejection fraction (EF). Material and methods: We prospectively studied 60 patients (50 men,10 women) with heart failure due to systolic dysfunction (left ventricular EF < 45%). All subjects were classified according the NYHA functional scale and received a specific questionnaire, as well as a home respiratory polygraphy and EKG Holter. A subject was considered to have SAS if their IAH > 15, and, according to standard recommendation, patients with IAH > 30 were treated with CPAP. After 3 months of treatment, the questionnaire, respiratory polygraphy and EKG Holter were repeated. Results: Age was 69.3 ± 10.4 years and the BMI was 28.5 ± 4.74 kg/m2. Of the total sample, 55% (33 cases) were habitual snorers. The Epworth scale scores were 7.83 ± 4.8. The EF was 36.3 ± 7.4%, and 36 patients were NYHA class II, 23 were class III, and one patient was class IV. A total of 38 patients had SAS (63%): 14 (36%) had central sleepapnea and 24 (64%) had obstructive sleep apnea. EF revealed no significant differences between the SAS and non-SAS groups (36.42 ± 7.6 vs.35.81 ± 6.6%, respectively). The SAS group presented a higher prevalence of bradicardia than the non-SAS group (24 % vs. 9%). After CPAP treatment, there was a significant improvement in EF (9%), in cases ofobstructive sleep apnea, but no significant improvement was observed in patients with central sleep apnea. Conclusions: The prevalence of SAS in patients with heart failuredue to systolic dysfunction is very high. CPAP treatment improved the EF in patients with obstructive sleep apnea

Absceso pulmonar por Aeromonas hydrophila / Lung abscess caused by aeromonas hydrophila

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[An epidemiological study of tuberculosis in the health area of Santiago de Compostela during the years 1989, 1990 and 1991]. / Estudio epidemiológico de la tuberculosis en el área sanitaria de Santiago de Compostela durante los años 1989, 1990 y 1991.

In order to assess the incidence of tuberculous disease in our health area, we reviewed the clinical records of patients from the three hospitals of the area under study during the years 1989, 1990 and 1991, who had positive bacilloscopy, positive Lowenstein's culture in any specimen and/or compatible anatomopathologic report. After excluding 26 patients because they belonged to other health areas, 885 patients remained in the study, out of which 251 (64% men and 36% women) were from the year 1989, 270 (64% men and 36% women) from the year 1990 and 364 (62% men and 38% women) from the year 1991. The mean age was 38.4 (SD 20.5). Fifty-one percent of the patients were between 20 and 35 years old. The rate of new cases was 65.87 per 100.000 population in 1989, 71.05 in 1990 and 95.53 in 1991. Seventy-four cases were HIV-positive (8%). Tuberculous meningitis was present in 12 patients. The highest mortality was 1.79 per 100.000 population in 1990. We conclude that tuberculosis presents a medium-high incidence in our health area.

[Bronchiolitis obliterans with organized pneumonia: apropos 2 new cases]. / Bronquiolitis obliterante con neumonía organizativa: a propósito de dos nuevos casos.

We present two cases of bronchiolitis obliterans organizing pneumonia (BOOP) with different clinical and radiological characteristics. In one case, the chest X-ray demonstrated bilateral migrating infiltrates. The pathology showed bronchiolar and intra-alveolar occupation by granulation tissue in both cases. It should be noted that both patients responded well to treatment with prednisone although alterations in gas exchange persisted in one case.