Modern and multidimensional approach of sleep apneea as a public health problem.

The obstructive sleep apnea syndrome (OSAS) is a highly prevalent disorder, associated with recurring episodes of partial or complete upper airway occlusion during sleep, which results in marked sleep disturbance, excessive daytime sleepiness, irritability and morning headache, among other symptoms. Sleep apnea is strongly associated with impaired neuropsychological function and reduced quality of life and social functioning. Daytime sleepiness leads to an increased risk for traffic and industrial accidents. OSAS is also independently associated with several cardiovascular complications: not only systemic hypertension but also ischaemic heart disease and stroke. Identifying patients "at risk" and treating them is very important, but at the same time it is time consuming and expensive. Nevertheless, treatment with continuous positive airway pressure (CPAP) has been shown to improve symptoms and quality of life, decrease traffic accidents and may have a positive effect on cardiovascular morbidity. That is why the economic aspects of sleep apnea and the current legislation are an important issue to discuss and manage, for both the patients and the society they live in.

[The impact of continuous positive pressure on systemic consequences and quality of life for patients with obstructive sleep apnea syndrome]. / Impactul tratamentului cu presiune pozitiv continua asupra consecintelor sistemice si calitatii vietii la pacientii cu sindrom de apnee în somn de tip obstructiv.

Obstructive sleep apnea syndrome (OSAS) is a complex disease, which frequently links and interacts with other conditions, such as cardiovascular disease, cerebrovascular disease, chronic obstructive pulmonary disease, erectile dysfunction. OSAS has a significant response on daily activities, including an increased risk for acute cardiovascular events, metabolic and respiratory events and a higher rate of road accidents. In this article, we intend to present some data about the impact of continuous positive pressure therapy (CPAP) on quality of life of patients with OSAS and it's systemic comorbidities, while trying to draw a warning as to the importance of early initiation of CPAP treatment, which, despite the increased cost, remains the gold standard in treating patients with OSAS.

[The non-invasive ventilation protocol in use at the University Lewisham Hospital--London]. / Protocolul University Hospital Lewisham--Londra pentru ventilatia non-invaziva.

The term non-invasive ventilation (NIV) includes both continuous positive pressure ventilation (CPAP) and non-invasive (bi-level) positive pressure ventilation (NIPPV). The introduction of NIV in clinical practice improved significantly the outcomes in patients with respiratory failure. The fact that NIV machines are simple to use, do not require endotracheal intubation, and can save lives, has led to their increased use by non ITU personnel. However, for an efficient use of NIV it is very important that the patients are treated according to strict local protocols. In order to support the writing of local NIV protocols in Romania, we present here the NIV protocol in use at the University Lewisham Hospital, London, United Kingdom.

[Chronic eosinophilic pneumonia--clinical case]. / Pneumonia eozinofilica cronica--prezentare de caz.

Eosinophilic pneumonia (EP) is a rare, heterogeneous group of respiratory diseases, characterized by eosinophilic pulmonary infiltrates, with or without peripheral blood eosinophilia. The hallmark of chronic eosinophilic pneumonia (CEP) is a massive accumulation of eosinophils in the lungs, and an increased number of eosinophils in the bronchoalveolar lavage (BAL) fluid. We present the case of a 58 years-old female patient who came to the Clinical Hospital of Pneumology "Leon Daniello" from Cluj Napoca, Romania, with the suspicion of a recurrent diffuse interstitial pneumonia, despite of a proper antibiotic and symptomatic treatment. After clinical and paraclinical investigations the patient was diagnosed with idiopathic chronic eosinophilic pneumonia. Corticosteroid treatment was started, with rapid improvement in both clinical and radiographic abnormalities.