Insuficiencia respiratoria hipercápnica aguda en pacientes con apneas del sueño / Acute Hypercapnic Respiratory Failure in Patients with Sleep Apneas

IntroducciónLa insuficiencia respiratoria hipercápnica aguda (IRHA) es una situación grave observada en algunos pacientes con síndrome de apneas-hipopneas del sueño (SAHS). El objetivo del presente estudio fue determinar las características clínicas de los pacientes con SAHS involucradas en el desarrollo de la IRHA y su pronóstico.Pacientes y métodoSetenta pacientes con SAHS consecutivos que sobrevivieron un episodio de IRHA y 70 pacientes con SAHS apareados por edad sin antecedentes previos de IRHA fueron estudiados y seguidos de forma prospectiva durante 3 años.ResultadosEl deterioro de la función pulmonar debido a la obesidad o a la coexistencia de enfermedad pulmonar obstructiva crónica fue frecuente en los pacientes con SAHS con IRHA. En el análisis multivariante, los factores de riesgo asociados con IRHA fueron la PaO2 basal, el porcentaje del valor teórico de la capacidad vital forzada y el consumo de alcohol y de benzodiacepinas. La mortalidad durante el seguimiento fue superior entre los pacientes que habían presentado IRHA respecto al grupo control. La principal causa de muerte fue la respiratoria, y la coexistencia de enfermedad pulmonar obstructiva crónica se identificó como un factor de riesgo de mortalidad.ConclusionesEl desarrollo de IRHA en pacientes con SAHS se asocia con la presencia de deterioro de la función pulmonar y con el consumo de alcohol y benzodiacepinas. Después del episodio de IRHA los pacientes presentaron una mortalidad elevada, principalmente de causa respiratoria. Se precisan nuevos estudios que evalúen las distintas alternativas terapéuticas disponibles en estos pacientes(AU)

IntroductionAcute hypercapnic respiratory failure (AHRF) is a serious condition observed in some patients with sleep apnea-hypopnea syndrome (SAHS). The objective of the present study was to study the clinical characteristics of SAHS patients who develop AHRF and their prognosis.Patients and methodA total of 70 consecutive SAHS patients who survived an AHRF episode and 70 SAHS patients paired by age with no previous history of AHRF were prospectively studied and followed up for 3 years.ResultsThe deterioration of lung function due to obesity or concomitant chronic obstructive pulmonary diseases (COPD) was common in SAHS patients with AHRF. In the multivariate analysis, the risk factors associated with AHRF were baseline PaO2, the theoretical percentage value of the forced vital capacity, alcohol consumption, and benzodiazepines. The mortality during follow up was higher among patients who had AHRF than in the control group. The main cause of death was respiratory, and the coexistence of COPD was identified as a mortality risk factor.ConclusionsThe development of AHRF in SAHS patients is associated with a deterioration in lung function and with alcohol and benzodiazepine consumption. The patients had a higher mortality after the AHRF episode, mainly a respiratory cause. New studies are required that evaluate the different available therapeutic options in these patients(AU)

[Acute hypercapnic respiratory failure in patients with sleep apneas]. / Insuficiencia respiratoria hipercápnica aguda en pacientes con apneas del sueño.

INTRODUCTION: Acute hypercapnic respiratory failure (AHRF) is a serious condition observed in some patients with sleep apnea-hypopnea syndrome (SAHS). The objective of the present study was to study the clinical characteristics of SAHS patients who develop AHRF and their prognosis. PATIENTS AND METHOD: A total of 70 consecutive SAHS patients who survived an AHRF episode and 70 SAHS patients paired by age with no previous history of AHRF were prospectively studied and followed up for 3 years. RESULTS: The deterioration of lung function due to obesity or concomitant chronic obstructive pulmonary diseases (COPD) was common in SAHS patients with AHRF. In the multivariate analysis, the risk factors associated with AHRF were baseline PaO(2,) the theoretical percentage value of the forced vital capacity, alcohol consumption, and benzodiazepines. The mortality during follow up was higher among patients who had AHRF than in the control group. The main cause of death was respiratory, and the coexistence of COPD was identified as a mortality risk factor. CONCLUSIONS: The development of AHRF in SAHS patients is associated with a deterioration in lung function and with alcohol and benzodiazepine consumption. The patients had a higher mortality after the AHRF episode, mainly a respiratory cause. New studies are required that evaluate the different available therapeutic options in these patients.

Adherence to nCPAP in patients with coronary disease and sleep apnea without sleepiness.

Many patients with obstructive sleep apnea (OSA) do not have sleepiness and adherence to nasal continuous positive airway pressure (nCPAP) is unknown when this treatment is primarily recommended for a cardiovascular concern. The aim of this study was to determine the adherence to nCPAP in patients with coronary artery disease (CAD) and OSA without sleepiness. nCPAP was recommended in 75 patients with CAD and OSA, 29 without and 46 with sleepiness. The daily use of nCPAP and changes in sleepiness (Epworth Sleepiness Scale), in other OSA symptoms and in SF-36 quality-of-life questionnaires were evaluated at 1 yr of follow-up. Sixty-seven patients (89%) were still using nCPAP at the end of follow-up. The absence of sleepiness at diagnosis did not imply a greater number of nCPAP refusals and nCPAP adherence was similar in both groups, 5.1 (1.5) h in patients without versus 5.4 (1.6) h in patients with sleepiness. In patients with sleepiness at diagnosis, the use of nCPAP was associated with reduced sleepiness and improvement in the OSA symptoms and quality-of-life questionnaires; in contrast, only the symptoms questionnaire improved in patients without sleepiness. In conclusion, in our experience adherence to nCPAP treatment in patients with CAD and OSA is not influenced by the absence of sleepiness.