Usefulness of cephalometry in sparing polysomnography of patients with suspected obstructive sleep apnea.

The aim of this investigation was to evaluate the contribution of cephalometry to a statistical model integrating clinical, physical, and oximetric variables, to reduce demands for polysomnographies. Two hundred and twenty-five consecutive patients that had been referred to the sleep clinic for suspected obstructive sleep apnea (OSA) were studied. The clinical assessment of all patients consisted of a sleep related questionnaire, the Epworth sleepiness scale, and a physical examination. In addition, they all underwent spirometry, cephalometry, and a full polysomnography. The clinical variables related with OSA were questions concerning witnessing of apneas by bed partners, intensity of snoring, a history of hypertension, and nocturia. A significant relation was also found with score on the Epworth scale, sex, age, body mass index, neck and waist circumferences, total number and frequency of oxygen desaturations, and the lowest oxygen saturation value. Significant cephalometric measurements were: the linear distance from gonion to gnathion, from the hyoid bone to the mandibular plane, and from the posterior nasal spine to the tip of the soft palate, and the thickness of the uvula as well. A statistical model was built to estimate a patient's probability of having OSA based on clinical variables, physical examination, pulse oximetry, and cephalometry. The validation of this model demonstrated a remarkable ability in reducing the number of polysomnographic studies. We conclude that cephalometry combined with clinical variables, physical examination, and nocturnal oximetry is useful in the diagnosis of OSA and enables the sparing of a considerable number of polysomnographies.

[Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia]. / Cierre percutáneo de foramen oval permeable en el síndrome platipnea-ortodesoxia.

Platypnea-orthodeoxia is a rare syndrome characterized by the occurrence of dyspnea and hypoxemia on adoption of an upright posture (i.e., orthodeoxia) and by the absence of symptoms and hypoxemia in decubitus. This syndrome is frequently related to patent foramen ovale and right-to-left shunting. We describe two patients in whom patent foramen ovale with right-to-left shunting was observed on transthoracic and transesophageal echocardiography and who had platypnea-orthodeoxia in the absence of pulmonary disease. They underwent transcatheter closure using an Amplatz device. The echocardiographic diagnosis and closure procedure are discussed. These case reports demonstrate that closure of patent foramen ovale is an effective treatment for platypnea-orthodeoxia.

Cierre percutáneo de foramen oval permeable en el síndrome platipnea-ortodesoxia / Transcatheter closure of patent foramen ovale in patients with platypnea-orthodeoxia

La platipnea-ortodesoxia es un síndrome poco frecuente que se caracteriza por disnea e hipoxemia en situación de bipedestación, con mejoría de los síntomas y recuperación de la hipoxemia con el decúbito. La asociación de este síndrome con un foramen oval permeable y un cortocircuito derecha-izquierda es muy frecuente. Describimos 2 casos de cierre percutáneo con dispositivo Amplatzer en pacientes en las que se observó un foramen oval permeable mediante estudio ecocardiográfico transtorácico y transesofágico, con paso derecha-izquierda en reposo y tras Valsalva, en mayor cantidad en la posición de sedestación respecto al decúbito y asociado con una desaturación arterial y disnea. Estos casos demuestran que el cierre del foramen oval permeable es un tratamiento eficaz de la platipnea-ortodesoxia

Platypnea-orthodeoxia is a rare syndrome characterized by the occurrence of dyspnea and hypoxemia on adoption of an upright posture (i.e., orthodeoxia) and by the absence of symptoms and hypoxemia in decubitus. This syndrome is frequently related to patent foramen ovale and right-to-left shunting. We describe two patients in whom patent foramen ovale with right-to-left shunting was observed on transthoracic and transesophageal echocardiography and who had platypnea-orthodeoxia in the absence of pulmonary disease. They underwent transcatheter closure using an Amplatz device. The echocardiographic diagnosis and closure procedure are discussed. These case reports demonstrate that closure of patent foramen ovale is an effective treatment for platypnea-orthodeoxia