Síndrome de obesidad-hipoventilación y factores asociados / Obesity-hypoventilation syndrome and associated factors

Fundamento y objetivos: La obesidad ocasiona alteraciones importantes de la fisiología respiratoria como el síndrome de apnea-hipoapnea del sueño (SAHS) y el síndrome de obesidad-hipoventilación (SOH), asociados ambos a elevada morbimortalidad. Además, estas entidades están claramente infradiagnosticadas y en el caso de SOH se desconoce la prevalencia en población general obesa. Los objetivos del estudio son: determinar la prevalencia del SOH en población de pacientes con obesidad mórbida y conocer la comorbilidad asociada al SOH, la clínica respiratoria y las alteraciones de la pulsioximetría. Pacientes y método: Estudio descriptivo. Se seleccionaron 136 pacientes adultos con obesidad mórbida (IMC >40). Se recogieron datos antropométricos, hábitos tóxicos, enfermedades concomitantes, registro de síntomas, datos analíticos, grado de disnea, escala de somnolencia, electrocardiograma y radiografía de tórax. También se realizó espirometría, pulsioximetría nocturna domiciliaria y gasometría arterial. Resultados: Se estudiaron 136 pacientes, con una media de edad de 60 años (DE: 12,9 años); el 73% (98) fueron mujeres. El 6,6% presentaban hipercapnia diurna indicativa de SOH. Presentaban hipertensión arterial (HTA) el 72%, dislipidemia el 44% y enfermedad cardiovascular (ECV) el 18%, sin diferencias según presentaran o no SOH. Tenían ronquidos el 83% y apneas el 46%. El 30% presentaban disnea gradoII y el 10% gradoIII. El índice de desaturaciones/hora (IDH) superior al 3% en ≥30 ocasiones estaba presente en el 28,6% de los pacientes y el porcentaje de tiempo con saturaciones de O2<90% más del 30% del tiempo lo presentaban el 23,5%, resultados peores en pacientes con SOH. Conclusiones: La prevalencia de SOH es más baja de la esperada. Destacan la elevada comorbilidad cardiovascular y frecuentes síntomas respiratorios, presenten o no SOH, así como alteraciones importantes en la pulsioximetría (AU)

Background and objectives: Obesity causes important alterations in the respiratory physiology like sleep obstructive apnoea (SOA) and obesity-hypoventilation syndrome (OHS), both associated with high morbidity and mortality. Also, these entities are clearly infradiagnosed and in the case of OHS the prevalence is unknown in the general obese population. To determine the prevalence of OHS in the population of patients with morbid obesity and to know the comorbidity related with OHS, the associated respiratory symptoms and the pulse oximetry alterations. Patients and method: Descriptive study. Selection of 136 adult patients with morbid obesity (BMI >40). Collected were, anthropometric data, toxic habits, concomitant disease, symptom data, analytic data, dyspnoea grade, sleepiness scale (Epworth Test), electrocardiogram, chest X-ray, spirometry, nocturne ambulatory pulse oximetry and arterial gasometry. Results: 136 were studied, mean age 60 years old (SD 12.9 years), 73% (98) were women; 6.6% of patients presented diurnal hypercapnia indicative of OHS; 72% presented high blood pressure, 44% dyslipidaemia, 18% presented cardiovascular disease, 83% snored and 46% had apnoea; 30% presented stageII dyspnoea and 10% stageIII. The desaturation/hour index was above 3% ≥30 of occasions in 28.6% of patients and the percentage of patients with saturations <90% more than 30% of the time was 23.5%. The results were worse in patients with OHS. Conclusions: The prevalence of OHS was lower than expected. Noteworthy was the high comorbidity of cardiovascular disease and the high frequency of respiratory symptoms associated with important alterations of pulse oximetry (AU)

Obesity-hypoventilation syndrome and associated factors. / Síndrome de obesidad-hipoventilación y factores asociados.

BACKGROUND AND OBJECTIVES: Obesity causes important alterations in the respiratory physiology like sleep obstructive apnoea (SOA) and obesity-hypoventilation syndrome (OHS), both associated with high morbidity and mortality. Also, these entities are clearly infradiagnosed and in the case of OHS the prevalence is unknown in the general obese population. To determine the prevalence of OHS in the population of patients with morbid obesity and to know the comorbidity related with OHS, the associated respiratory symptoms and the pulse oximetry alterations. PATIENTS AND METHOD: Descriptive study. Selection of 136 adult patients with morbid obesity (BMI >40). Collected were, anthropometric data, toxic habits, concomitant disease, symptom data, analytic data, dyspnoea grade, sleepiness scale (Epworth Test), electrocardiogram, chest X-ray, spirometry, nocturne ambulatory pulse oximetry and arterial gasometry. RESULTS: 136 were studied, mean age 60 years old (SD 12.9 years), 73% (98) were women; 6.6% of patients presented diurnal hypercapnia indicative of OHS; 72% presented high blood pressure, 44% dyslipidaemia, 18% presented cardiovascular disease, 83% snored and 46% had apnoea; 30% presented stageII dyspnoea and 10% stageIII. The desaturation/hour index was above 3% ≥30 of occasions in 28.6% of patients and the percentage of patients with saturations <90% more than 30% of the time was 23.5%. The results were worse in patients with OHS. CONCLUSIONS: The prevalence of OHS was lower than expected. Noteworthy was the high comorbidity of cardiovascular disease and the high frequency of respiratory symptoms associated with important alterations of pulse oximetry.

Disfunción ventricular transitoria o síndrome de Tako-Tsubo / Transient ventricular dysfunction or Tako-Tsubo syndrome

El síndrome de disfunción ventricular transitoria (SDAT) o Tako-Tsubo es una entidad que se presenta en mujeres de mediana edad, sin riesgo cardiovascular elevado, que se caracteriza por un cuadro clínico indicativo de síndrome coronario agudo de causa desconocida desencadenado por una situación de estrés súbito. Se presenta un caso clínico de este síndrome. Mujer de 46 años de edad, atendida de urgencias en su centro de salud por un cuadro de dolor torácico precordial, con cambios electrocardiográficos de lesión subepicárdica encara anterior. En el hospital de referencia, se detectó elevación de los marcadores de daño miocárdico. El cateterismo no mostró lesiones angiográficamente significativas. En la ventriculografía se observó aquinesia apical confracción de eyección disminuida. El resultado de las exploraciones complementarias orientó al diagnóstico de SDAT. El SDAT es una entidad a tener en cuenta en pacientes sin riesgo cardiovascular elevado, dada la diferente implicación pronóstica y de tratamiento (AU)

Transient ventricular dysfunction (TVD) or Tako-Tsubo syndrome is a disorder that occurs in middle aged women with an increased cardiovascular risk. It is characterised by a clinical picture suggestive of acute coronary syndrome of unknown cause, triggered by an acute stress situation. A clinical case of this syndrome is presented. A 46 year old female patient was seen as an emergency in her health centre die to a clinical picture of precordial chest pain with electrocardiography changes of an anterior subepicardiallesion. Increases in the myocardial damage markers were detected in the reference hospital. The angiographic catheter showed significant lesions. Ventriculography showed evidence of apical a kinesia with a decrease dejection fraction. The results of the complementary examinations led to the diagnosis of a transient ventricular dysfunction syndrome TVDS). TVDS is a condition to take into account inpatients who do not have a high cardiovascular risk given the prognostic and treatment implications (AU)

Cumplimiento terapéutico en pacientes con enfermedad cardiovascular / Therapeutic compliance in patients with cardiovascular disease

Introducción. El objetivo del estudio fue analizar el grado y las causas de incumplimiento mediante el test de Morisky-Green y compararlo con el juicio de cada médico de familia del centro de salud. Métodos. Se diseñó un estudio descriptivo transversal. Se realizó una selección aleatoria de 180 pacientes con enfermedad cardiovascular de 580 registrados. Se excluyeron los domiciliarios, los dependientes y los que se negaron a participar en el estudio. Mediante encuesta se recogió: sexo, edad, estudios, episodio cardiovascular y tiempo de evolución, número de diagnósticos y de fármacos y su posología. Se detectaron los no cumplidores con el test de Morisky-Green y se evaluaron las causas. Posteriormente se contrastó con la opinión de cada médico. Resultados. La media de edad fue de 70 años (desviación estándar [DE], 9,7), el 69% varones, el 91% con estudios primarios o analfabetos, el 75% tenía mínimo 4 diagnósticos y el 30% realizaba 10 o más tomas de medicamento diarias. Según el test, el 51% eran cumplidores, cifra similar a la opinión del médico (55%). La concordancia entre ambos fue muy baja (índice kappa = 0,14). La principal causa de incumplimiento fue olvidar las tomas (59%) y la segunda, negarse a depender de la medicación (20,5%). Conclusiones. La mitad de los pacientes era cumplidora según el test y según el juicio clínico del médico de familia, aunque había baja concordancia entre ambos. La principal causa de incumplimiento fue el olvido de la toma y la segunda negarse a depender de la medicación

Introduction. The aim of this study was to investigate the level and main reasons for non-compliance by using Morisky-Green's test. Later, this information was cross-checked with the opinion of the family doctor of each patient. Methods. A cross-sectional descriptive study was designed. 180 patients out of 580 with cardiovascular disease were randomly included. Home-care patients, those dependent and those who refused to be interviewed were excluded. By means of a questionnaire, gender, age, educational level, type of cardiovascular event, number of diagnoses, medication and dosage schedule were studied. Non-compliers were detected by the test and the main reason for non-compliance evaluated. Family doctors were also asked for their opinion. Results. The mean age was 70 years (standard deviation [SD], 9.7), 69% men, 91% with primary school studies or illiterate, 75% had a minimum of 4 diagnoses and 30% took more than 10 medications daily. According to the test, 51% had a good compliance, almost the same percentage when we asked the opinion of their doctor (55%). The concordance between both patient and doctor was very low (index kappa = 0.14). The main cause for non-compliance was forgetfulness (59%) and second was that the patients refused to be dependent on the medication (20.5%). Conclusions. Half of the patients had a good compliance according to the test and agreed with the opinion of their doctor, but there is little agreement between the 2 methods. The main reason for non-compliance was forgetfulness followed by refusing to depend on medication