Increased Incidence of Stroke, but Not Coronary Heart Disease, in Elderly Patients With Sleep Apnea.

Background and Purpose- The influence of age on the relationship between obstructive sleep apnea (OSA) and the incidence of hard cardiovascular events remains controversial. We sought to analyze the relationship between OSA and the incidence of stroke and coronary heart disease in a large cohort of elderly patients, as well as to investigate the role of continuous positive airway pressure (CPAP) treatment in these associations. Methods- Post hoc analysis of a prospective observational study of consecutive patients ≥65 years studied for OSA suspicion at 2 Spanish University Hospitals. Patients with an apnea-hypopnea index (AHI) <15 were the reference group. OSA was defined by an AHI ≥15 and classified as untreated (CPAP not prescribed or compliance <4 hours/day), mild-moderate (AHI 15-29), untreated severe (AHI ≥30), and CPAP-treated (AHI ≥15 and CPAP compliance ≥4 hours/day). Results- 859 and 794 elderly patients were included in the stroke and coronary heart disease analyses, respectively. The median (interquartile range) follow-up was 72 (50-88.5) and 71 (51.5-89) months, respectively. Compared with the reference group, the fully adjusted hazard ratios for the incidence of stroke were 3.42 (95% CI, 1.37-8.52), 1.02 (95% CI, 0.41-2.56), and 1.76 (95% CI, 0.62-4.97) for the untreated severe OSA group, CPAP-treated group, and untreated mild-moderate OSA group, respectively. No associations were shown between any of the different OSA groups and coronary heart disease incidence. Conclusions- The incidence of stroke, but not coronary heart disease, is increased in elderly patients with untreated severe OSA. Adequate CPAP treatment may reduce this risk.

Beyond Resistant Hypertension.

Obstructive sleep apnea (OSA) is an independent cause of resistant hypertension (RH) but its association with refractory hypertension (RfH), a recently described form of severe hypertension, has not yet been investigated. This study seeks to analyze the association between the presence and severity of OSA/OSA syndrome with RfH and to compare it with a group of patients with OSA/OSA syndrome and RH. We conducted a multicenter, cross-sectional study of consecutive patients diagnosed with RH by means of 24-hour ambulatory blood pressure monitoring. Those patients with blood pressure levels ≥130/80 mm Hg, despite taking at least 5 antihypertensive drugs, were considered to have true RfH. All patients underwent a sleep study and completed a detailed clinical history related to OSA, current medication, and cardiovascular diseases. Overall, 229 patients were included (mean age, 58.3 years; 63% male), of whom 42 (18.3%) satisfied the criteria for RfH. Compared with those with RH, patients with RfH had a higher cardiovascular risk profile, higher blood pressure measurements, and a 2-fold greater risk of having both severe OSA (odds ratio, 2.1, with a prevalence of apnea-hypopnea index ≥15, 95.2% and apnea-hypopnea index ≥30, 64.3%) and OSA syndrome (apnea-hypopnea index ≥5+Epworth Sleepiness Scale >10; odds ratio, 1.9; 52.4% versus 37.3%; P=0.023), as well as higher OSA severity (apnea-hypopnea index, 41.8 versus 33.8 events/h; P=0.026). Patients with RfH had an even greater prevalence and severity of OSA and OSA syndrome than RH patients, highlighting the need to identify these patients to refer them to sleep units on a preferential basis.

Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients.

BACKGROUND: Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma. METHODS: Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spreading of the melanoma) was performed. RESULTS: Patients in the upper tertiles of AHI or DI4% were 1.94 (95% CI, 1.14-3.32; P = .022) and 1.93 (95% CI, 1.14-3.26; P = .013) times more likely, respectively, to present with aggressive melanoma (Breslow index > 1 mm) than those in the lowest tertiles of these sleep attributes after adjustment for age, sex, tumor location, and BMI. This association was particularly prominent among patients < 56 years of age with Breslow index > 2 mm. The presence of the additional markers of aggressiveness was also associated with higher AHI and DI4% values. CONCLUSIONS: The severity of SDB was independently associated with greater aggressiveness of cutaneous melanoma, particularly among younger patients.

Impacto del síndrome de apneas-hipopneas durante el sueño en el anciano / Sleep apnea-hypopnea syndrome impact in the elderly. Towards a specific diagnosis and therapeutic approach

La prevalencia y la gravedad del Síndrome de Apneas-Hipopneas durante el sueño (SAHS) aumentan con la edad. A pesar de ello se trata de una enfermedad infradiagnosticada y actualmente no existe un consenso claro sobre cual debe ser el enfoque diagnóstico y terapéutico de los pacientes de edad avanzada. El número de ancianos está aumentando en nuestro país de manera significativa en los últimos años, así como el número de pacientes de edad avanzada remitidos a las Unidades de Sueño para estudio de un posible SAHS, probablemente como consecuencia de una mayor concienciación de las consecuencias negativas sobre la salud de esta enfermedad. Se estima que una cuarta parte de los estudios de sueño se realiza en pacientes mayores de 65 años y de estos a más de la mitad se les prescribe tratamiento con presión positiva continua en la vía aérea (CPAP) sin una evidencia científica clara que lo justifique. A falta de nuevas recomendaciones específicas, las guías vigentes sostienen que la edad no debe ser un factor limitante a la hora de decidir el tratamiento de los pacientes de edad avanzada. Dado el incremento en la longevidad observado en las últimas décadas en nuestro país, el elevado gasto que supone esta patología y las consecuencias sobre la salud en los individuos que la padecen, descubrir cuál es el diagnóstico y tratamiento más apropiado en los pacientes de edad avanzada con SAHS debe ser un objetivo prioritario en la investigación clínica (AU)

The prevalence and severity of sleep apnea-hypopnea syndrome (SAHS) increases with age. Nevertheless it is an underdiagnosed disease and there is currently no clear consensus on which should be the diagnostic and therapeutic approach in the elderly. In the last few years the elderly population is significantly increasing in our country, and the number of elderly patients referred to the Sleep Unit for suspected SAHS is also increasing, probably due to the increased awareness of the negative consequences of this disease on health. It is estimated that a quarter of the sleep studies are performed in patients older than 65 years and in more than a half of them the treatment with continuous positive airway pressure (CPAP) is prescribed with no clear scientific evidence to support it. In the absence of specific recommendations, current guidelines state that age should not be a limiting factor when deciding on the treatment of elderly patients. Considering the increased longevity observed in recent decades in our country, the high economic cost of this pathology and its consequences on health, it should be a priority in clinical research to find out what is the most appropriate diagnosis and treatment in this age froup (AU)

Prognostic value of bronchiectasis in patients with moderate-to-severe chronic obstructive pulmonary disease.

RATIONALE: The prevalence of bronchiectasis is high in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and it has been associated with exacerbations and bacterial colonization. These have demonstrated some degree of prognostic value in patients with COPD but no information about the relationship between bronchiectasis and mortality in patients with COPD is currently available. OBJECTIVES: To assess the prognostic value of bronchiectasis in patients with moderate-to-severe COPD. METHODS: Multicenter prospective observational study in consecutive patients with moderate-to-severe COPD. Bronchiectasis was diagnosed by high-resolution computed tomography scan. A complete standardized protocol was used in all patients covering general, anthrophometric, functional, clinical, and microbiologic data. After follow-up, the vital status was recorded in all patients. Multivariate Cox analysis was used to determine the independent adjusted prognostic value of bronchiectasis. MEASUREMENTS AND MAIN RESULTS: Ninety-nine patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) II, 85 in GOLD III, and 17 in GOLD IV stages were included. Bronchiectasis was present in 115 (57.2%) patients. During the follow-up (median, 48 mo [interquartile range, 35-53]) there were 51 deaths (43 deaths in the bronchiectasic group). Bronchiectasis was associated with an increased risk of fully adjusted mortality (hazard ratio, 2.54; 95% confidence interval, 1.16-5.56; P = 0.02). CONCLUSIONS: Bronchiectasis was associated with an independent increased risk of all-cause mortality in patients with moderate-to-severe COPD.

Revisón: apnea del sueño y atención primaria. Una relación necesaria / No disponible

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