An unusual presentation of severe obstructive sleep apnea with nocturnal seizure-like movements: A case report.

Key Clinical Message: This study suggests that severe obstructive sleep apnea can present as sleep-related epileptic or non-epileptic seizures. A detailed history and physical examination, along with polysomnography and video electroencephalography findings can lead to the correct diagnosis. Abstract: Obstructive sleep apnea (OSA) is defined by recurrent episodes of the upper airway complete or partial collapse while sleeping. The obstructive episodes result in gradual suffocation that increases breathing attempts till the person is awakened. The main manifestations are excessive daytime sleepiness, snoring, observed episodes of stopped breathing, and abrupt awakenings accompanied by gasping or choking. Nevertheless, there are very few reports of patients with OSA, manifesting other symptoms such as seizure-like movements. Differentiating OSA with nocturnal seizures could be challenging due to their overlapping features. A 53-year-old man presented to the clinic, experiencing seizure-like involuntary movements during nocturnal sleep for the past 2 years with a frequency of 2-3 times per night. Neurologic examinations were normal. Further evaluation with polysomnography revealed impaired arousal followed by seizure-like movements during sleep. Video electroencephalography (EEG) did not show any epileptiform discharges, ruling out the nocturnal seizure diagnosis. The patient was diagnosed with OSA. Subsequently, continuous positive airway pressure (CPAP) treatment resolved all symptoms.

Pharmacological interventions for pediatric obstructive sleep apnea (OSA): Network meta-analysis.

IMPORTANCE: Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of different pharmacologic interventions for the treatment of OSA in children is still lacking. OBJECTIVE: This study aims to conduct a comprehensive systematic review and network meta-analysis of pharmacological interventions for the management of obstructive sleep apnea in pediatric population. DATA SOURCES: PubMed, Web of Science, Embase, The Cochrane Library, and CNKI were searched from 1950 to November 2022 for pediatric OSA. STUDY SELECTION: Multiple reviewers included Randomized controlled trials (RCTs) concerning drugs on OSA in children. DATA EXTRACTION AND SYNTHESIS: Multiple observers followed the guidance of the PRISMA NMA statement for data extraction and evaluation. Bayesian network meta-analyses(fixed-effect model) were performed to compare the weighted mean difference (WMD), logarithmic odds ratios (log OR), and the surface under the cumulative ranking curves (SUCRA) of the included pharmacological interventions. Our protocol was registered in PROSPERO website (CRD42022377839). MAIN OUTCOME(S) AND MEASURE(S): The primary outcomes were improvements in the apnea/hypopnea index (AHI), while secondary outcomes included adverse events and the lowest arterial oxygen saturation (SaO2). RESULTS: 17 RCTs with a total of 1367 children with OSA aged 2-14 years that met the inclusion criteria were eventually included in our systematic review and network meta-analysis. Ten drugs were finally included in the study. The results revealed that Mometasone + Montelukast (WMD-4.74[95%CrIs -7.50 to -2.11], Budesonide (-3.45[-6.86 to -0.15], and Montelukast(-3.41[-5.45 to -1.39] exhibited significantly superior therapeutic effects compared to the placebo concerning apnea hypopnea index (AHI) value with 95%CrIs excluding no effect. Moreover, Mometasone + Montelukast achieved exceptionally high SUCRA values for both AHI (85.0 %) and SaO2 (91.0 %). CONCLUSIONS AND RELEVANCE: The combination of mometasone furoate nasal spray and oral montelukast sodium exhibits the highest probability of being the most effective intervention. Further research is needed to investigate the long-term efficacy and safety profiles of these interventions in pediatric patients with OSA.

Pharmacological treatment for obstructive sleep apnea: A systematic review and meta-analysis.

OBJECTIVE: Summarize the evidence on drug therapies for obstructive sleep apnea. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Embase, Scopus, Web of Science, SciELO, LILACS, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched on February 17th, 2023. A search strategy retrieved randomized clinical trials comparing the Apnea-Hypopnea Index (AHI) in pharmacotherapies. Studies were selected and data was extracted by two authors independently. The risk of bias was assessed using the Cochrane Risk of Bias tool. RevMan 5.4. was used for data synthesis. RESULTS: 4930 articles were obtained, 68 met inclusion criteria, and 29 studies (involving 11 drugs) were combined in a meta-analysis. Atomoxetine plus oxybutynin vs placebo in AHI mean difference of -7.71 (-10.59, -4.83) [Fixed, 95 % CI, I2 = 50 %, overall effect: Z = 5.25, p < 0.001]. Donepezil vs placebo in AHI mean difference of -8.56 (-15.78, -1.33) [Fixed, 95 % CI, I2 = 21 %, overall effect: Z = 2.32, p = 0.02]. Sodium oxybate vs placebo in AHI mean difference of -5.50 (-9.28, -1.73) [Fixed, 95 % CI, I2 = 32 %, overall effect: Z = 2.86, p = 0.004]. Trazodone vs placebo in AHI mean difference of -12.75 (-21.30, -4.19) [Fixed, 95 % CI, I2 = 0 %, overall effect: Z = 2.92, p = 0.003]. CONCLUSION: The combination of noradrenergic and antimuscarinic drugs shows promising results. Identifying endotypes may be the key to future drug therapies for obstructive sleep apnea. Moreover, studies with longer follow-up assessing the safety and sustained effects of these treatments are needed. PROSPERO REGISTRATION NUMBER: CRD42022362639.

Central and mixed apneas in children with obstructive sleep apnea: effect of adenotonsillectomy.

PURPOSE: Investigate the effect of adenotonsillectomy on mixed apnea index (MAI) and central apnea index (CAI) in children with moderate-to-severe obstructive sleep apnea syndrome (OSAS). METHODS: Observational retrospective analysis of polysomnographic data in children diagnosed with moderate-to-severe OSAS and without comorbidity, submitted to adenotonsillectomy. RESULTS: Data were available for 80 children, 55 boys and 25 girls, with a median age of 3.6 years (2.1-5.9). Before surgery AHI was 14.1 (11.0-18.4) per hour, with a median preoperative OAI of 7.1 (4.1-10.6), MAI of 1.2 (0.6-1.6) and CAI of 1.0 (0.4-2.0). Adenotonsillectomy caused significant improvements in MAI, from 1.2 (0.6-1.6) to 0.5 (0.1-0.8) (p < 0.001) and CAI from 1.0 (0.4-2.0) to 0.5 (0.1-0.9) (p < 0.001). This represents a normalization of MAI in 91.7% and CAI in 75.6% of children that had an abnormal value prior surgery. CONCLUSION: Non obstructive apneas are common in children with OSAS. Adenotonsillectomy caused significant decrease not only in OAI, but also in MAI and CAI in children with moderate-to-severe OSAS.

Pharmacological treatment for obstructive sleep apnea: A systematic review and meta-analysis

Abstract Objective Summarize the evidence on drug therapies for obstructive sleep apnea. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Embase, Scopus, Web of Science, SciELO, LILACS, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched on February 17th, 2023. A search strategy retrieved randomized clinical trials comparing the Apnea-Hypopnea Index (AHI) in pharmacotherapies. Studies were selected and data was extracted by two authors independently. The risk of bias was assessed using the Cochrane Risk of Bias tool. RevMan 5.4. was used for data synthesis. Results 4930 articles were obtained, 68 met inclusion criteria, and 29 studies (involving 11 drugs) were combined in a meta-analysis. Atomoxetine plus oxybutynin vs placebo in AHI mean difference of -7.71 (-10.59, -4.83) [Fixed, 95 % CI, I2 = 50 %, overall effect: Z = 5.25, p < 0.001]. Donepezil vs placebo in AHI mean difference of -8.56 (-15.78, -1.33) [Fixed, 95 % CI, I2 = 21 %, overall effect: Z = 2.32, p = 0.02]. Sodium oxybate vs placebo in AHI mean difference of -5.50 (-9.28, -1.73) [Fixed, 95 % CI, I2 = 32 %, overall effect: Z = 2.86, p = 0.004]. Trazodone vs placebo in AHI mean difference of -12.75 (-21.30, -4.19) [Fixed, 95 % CI, I2 = 0 %, overall effect: Z = 2.92, p = 0.003]. Conclusion The combination of noradrenergic and antimuscarinic drugs shows promising results. Identifying endotypes may be the key to future drug therapies for obstructive sleep apnea. Moreover, studies with longer follow-up assessing the safety and sustained effects of these treatments are needed. PROSPERO registration number CRD42022362639.

[Lung manifestations of sickle-cell disease]. / Manifestations respiratoires de la drépanocytose.

Sickle-cell disease is an autosomal recessive genetic disorder of hemoglobin that causes systemic damage. Hypoxia is the main actor of sickle-cell disease. It initiates acutely the pathogenic cascade leading to tissue damages that in turn induce chronic hypoxia. Lung lesions represent the major risk of morbidity and mortality. Management of sickle-cell disease requires a tight collaboration between hematologists, intensivists and chest physicians. Recurrent episodes of thrombosis and hemolysis characterize the disease. New therapeutic protocols, associating hydroxyurea, transfusion program and stem cell transplantation in severe cases allow a prolonged survival until the fifth decade. However, recurrent pain, crisis, frequent hospital admissions due to infection, anemia or acute chest syndrome and chronic complications leading to organ deficiencies degrade the patients' quality of life. In low-income countries where the majority of sickle-cell patients are living, the disease is still associated with a high mortality in childhood. This paper focuses on acute chest syndrome and chronic lung manifestations.

Guidelines of the French Society of ENT (SFORL): Drug-induced sleep endoscopy in adult obstructive sleep apnea syndrome.

OBJECTIVES: To determine the indications, anesthesiological and surgical procedure and interest of drug-induced sleep endoscopy in the treatment of adult obstructive sleep apnea syndrome. DESIGN: A redactional committee of 17 experts was set up. Conflicts of interest were disclosed and followed up throughout the process of drawing up the guidelines. The work received no funding from any firm dealing in health products (drugs or devices). The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was applied to assess the quality of the data on which the guidelines were founded. It was stressed that strong recommendations should not be made on the basis of poor-quality or insufficient data. METHODS: The committee studied 29 questions on 5 topics: indications and contraindications, anesthetic technique, surgical technique, interpretation and reporting of results, and management guided by results. RESULTS: Expert review and application of the GRADE method led to 30 guidelines: 10 with high level of evidence (Grade 1+ or 1-), 19 with low level (GRADE 2+ or 2-) and 1 expert opinion. CONCLUSION: Experts fully agreed on the strong guidelines formalizing the indications and modalities of drug-induced sleep endoscopy for adult obstructive sleep apnea syndrome.

CPAP Pressure Prediction Calculation. An Alternative to the Difficulty of Performing a Titration Within the Context of the COVID19 Pandemic

Abstract Introduction: The treatment of choice for the obstructive sleep apnea-hypopnea syndrome (OSAHS) is continuous positive air pressure in the airway (CPAP), titrating the effective pressure that eliminates obstructive events through validated methods. From the beginning of the COVID 19 pandemic, it has been recommended that conventional titration should be postponed, replacing it with self-adjusting equipment. In our population, access to these devices is difficult. Objective: To show whether there is a difference between the CPAP pressure level calculated through a prediction formula and the pressure determined by titration under polysomnography. Materials and Methods: We included patients with OSAHS who underwent effective CPAP titration and compared it with the cal culated CPAP by the Miljeteig and Hoffstein formula. Results: We included medical records of 583 patients, (56%) men, 51 years (41-61), apnea-hypopnea index (AHI) of 51.3 (29.2 -84.4), calculated CPAP, 9.3 cm H2O vs. effective CPAP, 8 cm H2O (p < 0.0001). Comparing according to the degree of severity of the OSAHS, the average difference between calculated CPAP and effective CPAP was 0.24, 0.21, and 0.41 (non-significant differences) for mild, moderate and severe, up to an AHI < 40; in patients with an AHI ≥ 40 this difference was 1.10 (p < 0.01). We found an ac ceptable correlation between the calculated CPAP and the effective CPAP, with an intraclass correlation coefficient of 0.621, p < 0.01. Conclusion: We could use CPAP pressure prediction calculations to start treatment in patients with OSAHS who don't have access to self-adjusting therapies within the context of the pandemic, until standard calibration measures can be taken.

A New Wearable System for Home Sleep Apnea Testing, Screening, and Classification.

We propose an unobtrusive, wearable, and wireless system for the pre-screening and follow-up in the domestic environment of specific sleep-related breathing disorders. This group of diseases manifests with episodes of apnea and hypopnea of central or obstructive origin, and it can be disabling, with several drawbacks that interfere in the daily patient life. The gold standard for their diagnosis and grading is polysomnography, which is a time-consuming, scarcely available test with many wired electrodes disseminated on the body, requiring hospitalization and long waiting times. It is limited by the night-by-night variability of sleep disorders, while inevitably causing sleep alteration and fragmentation itself. For these reasons, only a small percentage of patients achieve a definitive diagnosis and are followed-up. Our device integrates photoplethysmography, an accelerometer, a microcontroller, and a bluetooth transmission unit. It acquires data during the whole night and transmits to a PC for off-line processing. It is positioned on the nasal septum and detects apnea episodes using the modulation of the photoplethysmography signal during the breath. In those time intervals where the photoplethysmography is detecting an apnea, the accelerometer discriminates obstructive from central type thanks to its excellent sensitivity to thoraco-abdominal movements. Tests were performed on a hospitalized patient wearing our integrated system and the type III home sleep apnea testing recommended by The American Academy of Sleep Medicine. Results are encouraging: sensitivity and precision around 90% were achieved in detecting more than 500 apnea episodes. Least thoraco-abdominal movements and body position were successfully classified in lying down control subjects, paving the way toward apnea type classification.

Hipertensión Arterial Secundaria ¿por dónde empezar? / Secondary Arterial Hypertension, where to start?

30 to 40% of the adult population worldwide has been diagnosed with hypertension, among these patients 5 to 10% of them could have a possibly curable condition. In order to recognize this special population, the clinician must perform a complete work up and be aware of the main underlying causes of secondary hypertension. Often this could be a goal difficult to accomplish. The purpose of this article is to discuss the most frequent causes of secondary hypertension and offer a diagnostic approach for these patients. Clinicians should never forget that drug-related hypertension is a common cause that is discovered only with the help of a good medical history.

[Prevalence and characteristics of obstructive sleep apneas according to severity]. / Prevalencia y características de apneas obstructivas de sueño según gravedad.

Obstructive sleep apnea (OSA) is a prevalent condition. OSA is defined as very severe when the apneas/ hypopneas index (AHI) is greater than 60 events/hour. However, its prevalence remains uncertain. The aim of this study was to describe the prevalence and characteristics from patients with OSA according to severity. We performed a retrospective analysis of patients > 18 years, assessed by respiratory polygraph. We evaluated a total of 5670 patients with a mean of age of 54.4 ± 14.3 years old, of which 3606 were included in the OSA group. The overall prevalence of very severe OSA was 4.8%, being higher in men than in women (6.8 vs 1.9%). This group of patients was younger than the less severe groups (54.7 ± 13.9: mild OSA; 56.5 ± 12.9: moderate OSA; 57.9 ± 13.0: severe OSA vs 51.5 ± 12.9 years in the very severe patients; p < 0.0001). The results showed a significant increase in the body mass index (BMI) of patients with very severe OSA (31.6 ± 6.9: mild OSA, 32.8 ± 6.6: moderate OSA, 34.0 ± 6.8 severe OSA vs 37.1 ± 8.5 extreme severity; p < 0.0001), with similar results in men, but not in women. Finally, drowsiness due to ESS > 10, showed a significant increase in the very severe group of both sexes; 43.2% vs 31.5% (severe OSA); 26.4% (moderate OSA) and 23.8% (mild OSA). Very severe OSA presented a prevalence of 4.8% of patients with OSA. According to previous publications in other studied populations, we found that patients with very severe OSA are younger and more obese than the less severe groups.

La apnea obstructiva del sueño (AOS) constituye una afección prevalente. Se define AOS muy grave cuando el índice de apneas/hipopneas (IAH) es mayor a 60 eventos/hora. Sin embargo, su prevalencia sigue siendo incierta. El objetivo de este estudio fue d escribir la prevalencia y características de pacientes con AOS según la gravedad. Se realizó un análisis retrospectivo de pacientes > 18 años, evaluados mediante poligrafía respiratoria. Fueron evaluados 5670 de los cuales se incluyeron 3606 pacientes con AOS, con una media de edad de 54.4 ± 14.3 años. La prevalencia global de AOS muy grave fue de 4.8%, siendo mayor en hombres que en mujeres (6.8 vs. 1.9). Este grupo resultó más joven que los grupos de menor gravedad (54.7 ± 13.9: AOS leve; 56.5 ± 12.9: AOS moderado; 57.9 ± 13.1: AOS grave vs. 51.5 ± 12.9 años en los muy graves; p < 0.0001). Los resultados mostraron un aumento significativo del índice de masa corporal en aquellos con AOS muy grave (31.6 ± 6.9: AOS leve, 32.8 ± 6.6: AOS moderado, 34.0 ± 6.8 AOS grave vs. 37.1 ± 8.5 de gravedad extrema; p < 0.0001), con resultados similares en hombres, pero no en mujeres. Finalmente, la somnolencia por ESS > 10, mostró un aumento significativo en el grupo muy graves de ambos sexos; 43.2% vs. un 31.5% (AOS grave); 26.4% (AOS moderado) y un 23.8% (AOS leve). El AOS muy grave presenta una prevalencia del 4.8% de los pacientes con AOS. En acuerdo con publicaciones previas en otras poblaciones estudiadas, encontramos que los pacientes con AOS muy graves, son más jóvenes y obesos que los grupos de menor gravedad.

Síndrome de apneas e hipopneas obstructivas del sueño posicional / Positional Obstructive Sleep Apnea/Hypopnea Syndrome

La posición del cuerpo influye en la frecuencia y duración de apneas e hipopneas en los individuos con apneas obstructivas del sueño. La posición en decúbito supino es en la que más frecuentemente se registran eventos obstructivos y por lo tanto mayores valores en los indicadores de severidad. Aunque existen diferentes definiciones y clasificaciones, el síndrome de apneas del sueño posicional representa el 60% de todos los pacientes evaluados en una unidad de sueño, y su diferenciación tiene por objetivo determinar cuáles serán los candidatos que se beneficiarían de terapia posicional. Hasta el momento no hay una definición aceptada universalmente y la evidencia del beneficio clínico del rol de clasificar a los pacientes con apneas posicionales es aún controvertida en numerosos aspectos. La terapia posicional se basa en disminuir el tiempo en supino y la severidad de los eventos obstructivos, herramienta de la que se beneficiaría una importante proporción de los pacientes. La CPAP es el tratamiento más eficaz y se recomienda en formas severas y moderadas con manifestaciones clínicas y antecedentes cardiovasculares. En este grupo la terapia posicional podría recomendarse como tratamiento coadyuvante.

Body position during sleep time influences the frequency and duration of apneas and hypopneas in individuals who suffer from obstructive sleep apnea. Individuals in supine position show higher frequency of obstructive events and therefore, higher values in severity indexes. Though there are different definitions and classifications, the positional sleep apnea syndrome represents 60% of all patients evaluated in a sleep unit, and differentiating it aims to determine which candidates will benefit from positional therapy. There is no universally accepted definition and the evidence of the clinical benefit of classifying patients with positional sleep apnea is still controversial in many aspects. Positional therapy has the purpose of decreasing supine time and the severity of obstructive events. A significant proportion of patients would benefit from this treatment. The continuous positive airway pressure (CPAP) is the most effective treatment and is recommended for severe and moderate forms with clinical manifestations and cardiovascular history. In this group, positional therapy could be recommended as adjuvant treatment.

Opioid-Related Sleep-Disordered Breathing: An Update for Clinicians.

Opioids are an effective treatment for patients with intractable pain. Long-term administration of opioids for pain relief is being delivered by an increasing number of medical providers in the United States including primary care physicians and nonspecialists. One common complication of chronic opioid use is sleep-disordered breathing which can result in various morbidities as well as an increase in all-cause mortality. It is important for providers to understand the relationship between opioids and sleep-disordered breathing as well as methods to improve diagnosis and strategies for treatment. This review aims to update clinicians on the mechanism, diagnosis, and treatment of opioid-related sleep-disordered breathing in order to improve the quality of care for patients with chronic pain.

Selección de máscaras para el tratamiento con CPAP en el síndrome de apneas obstructivas del sueño / Mask Selection for Treatment with CPAP in Obstructive Sleep Apnea Syndrome

La presión positiva continua en las vías aéreas (CPAP) es el tratamiento estándar más eficaz para el síndrome de apneas e hipopneas obstructivas del sueño (SAHOS). La falta de adherencia se debe con frecuencia a la incomodidad o el disconfort generados por efectos secundarios relacionados con las máscaras. La aceptación de la CPAP depende en gran medida de la selección de la interfaz adecuada y para ello se requiere de experiencia del personal, de la posibilidad de seleccionar el modelo que mejor se adapta a cada paciente, y de que las interfaces cumplan con requisitos mínimos para proporcionar confort y eficacia terapéutica. La evidencia actual sugiere que la máscara nasal es mejor tolerada, requiere menor presión para resolver la obstrucción y se asocia con una mejor calidad de sueño y adherencia al tratamiento. Por lo tanto, máscaras o almohadillas nasales deben ser la primera opción. Máscaras oronasales pueden ser apropiadas cuando no se tolere la máscara nasal o la fuga bucal documentada persista. Los especialistas en medicina respiratoria somos responsables de controlar el proceso de selección y suministro de la máscara y de orientar a nuestros pacientes acerca de las opciones disponibles.

Continuous positive airway pressure (CPAP) is the most effective standard treatment for the obstructive sleep apnea and hypopnea syndrome (OSAHS). The lack of adherence to the treatment is frequently due to inconvenience or discomfort generated by side effects related to the masks. CPAP acceptance depends greatly on the selection of the adequate interface. To make the right choice, it is necessary to have experienced personnel and the possibility to select the model that best suits every patient. Also, interfaces must meet minimum requirements to provide comfort and therapeutic efficacy. Current evidence suggests that the nasal mask is better tolerated, requires less pressure to solve obstructions and is associated with better quality of sleep and adherence to the treatment. So, nasal masks or pillows should be the first option. Oronasal masks may be suitable when the nasal mask is not tolerated or the documented oral leakage persists. Specialists in respiratory medicine are responsible for controlling the process of selection and administration of the mask and guiding our patients on the available options.

Nocturnal Hypoxemia Impacts Right Ventricle Diastolic Function in Obstructive Sleep Apnea: A Retrospective Observational Study.

Obstructive sleep apnea (OSA), although a growing healthcare problem and documented risk factor for cardiovascular diseases, is still under-diagnosed in cardiac patients. To investigate the correlation between OSA and echocardiographic parameters of right ventricle diastolic (RVD) dysfunction, in particular trans-tricuspid E-wave deceleration time (EDT), we retrospectively analyzed data of 103 pure (comorbidity-free) OSA patients with comprehensive echocardiographic examination (ETT). Apnea/hypopnea index (AHI), oxygen desaturation index (ODI), mean nighttime oxyhemoglobin saturation (SpO2), time elapsed with SpO2 < 90% (T90) and mean peak desaturation of nocturnal events (Mdes, graded as mild, medium or severe) were compared with echocardiographic parameters. We found RVD dysfunction present in 58.3% of patients. Altered EDT correlated significantly with mean SpO2, T90, and Mdes (p < 0.01, all). Nocturnal desaturators had a significantly worse EDT than non-desaturators (p = 0.027) and a higher risk of prolonged EDT (odds ratio, OR = 2.86). EDT differed significantly according to Mdes severity (p = 0.005) with a higher risk of prolonged EDT in medium/severe vs. mild Mdes (OR = 3.44). EDT detected the presence of RVD dysfunction in 58.3% of our pure OSA patients. It correlated poorly with AHI severity but strongly with nocturnal desaturation severity, independently of age. This ETT marker may be useful for deciding appropriate diagnostic and therapeutic strategies.

Clinical Characteristics of Patients with Very Severe Obstructive Sleep Apnea

Introduction: The presence of obstructive sleep apneas (OSA) is a prevalent disease, whose severity is determined from the Apnea- Hypopnea Index (AHI). Very severe OSA (vsOSA) is defined by an AHI ≥ 60 events/hour; with clinical characteristics that could be different. The purpose of this study was to describe the clinical characteristics of patients with sOSA and compare them with less severe manifestations of this disease. Materials and Methods: Retrospective study of patients referred to a specialized hypertension center who met clinical criteria for the study of OSA. Patients were analyzed by means of a respiratory polygraphy, Ambulatory Monitoring of Arterial Pressure (AMAP), questionnaires and laboratory tests. We used non-parametric tests for the analysis of the results. Results: Of the 115 patients with OSA included in the study, 57 showed moderate OSA (mOSA), 48 sOSA and 10 vsOSA. No statistically significant differences were observed in age, Body Mass Index (BMI), glycemia, percentage of diabetic patients, or waist or neck diameter. We observed that the proportion of patients with arterial hypertension became higher as the severity of the OSA increased. This increase was significant only regarding the value of diastolic arterial pressure in very severe patients (vsOSA: 94.0 ± 7.7 mmHg vs. sOSA: 87.9 ± 8.7 mmHg and mOSA: 84.4 ± 8.2 mmHg; p < 0.05 and p < 0.01, respectively). Conclusions: In agreement with previous studies, our patients with vsOSA showed a higher degree of diastolic hypertension with clinical characteristics similar to less severe manifestations of OSA.

Characterization of Hemodynamic Patterns in Patients with Arterial Hypertension and Obstructive Sleep Apneas: Pilot Study Using Impedance Cardiography

Introduction: Arterial hypertension and obstructive sleep apneas are high prevalence diseases frequently associated. Understanding the hemodynamic profiles would allow treatment administration basing on the changes produced by the combination of both diseases. Materials and Methods: A prospective, exploratory pilot study was conducted with the purpose of characterizing the hemodynamic patterns of patients referred to the Arterial Hypertension Center who were without pharmacological treatment at the time of consultation. The hemodynamic pattern and thoracic fluid content were evaluated by impedance cardiography. In addition, office and 24-hour ambulatory monitoring of arterial pressure values were recorded; and the suspicion of sleep apnea was objectively assessed by means of home respiratory polygraphy. Results: 58 patients were included. The diagnosis of sleep apnea was confirmed in 84.5% of the cases (46.5% moderate to severe), and arterial hypertension in 65.2%. The findings of this study showed a progressive decrease in the proportion of the normodynamic pattern and normal thoracic fluid content, in relation to the increase in the severity of the respiratory sleep disorder (p 0.5). Furthermore, office systolic and diastolic pressure showed a progressive increase in relation to the increase in the severity of sleep apnea (p 0.05 and 0.01). Conclusion: The moderate-severe respiratory sleep disorder was related to an increase in resting blood pressure and a trend that did not reach statistical significance in the findings of altered hemodynamic patterns.

[STOP-BANG, a useful and easy tool for the screening of obstructive sleep apnea]. / STOP-BANG, una herramienta útil y sencilla para el cribado del síndrome de apneas hipopneas obstructivas del sueño.

The STO-BANG questionnaire, S standing for snore, T tired, O observed apneas, P pressure (arterial hypertension), B BMI (body mass index > 35 kg/ m2), A age (> 50 years old), N neck circumference (> 40 cm), G gender (male); is a simple tool that enables the detection of patients with obstructive sleep apnea syndrome (OSA). If the patient adds 3 or more points, it is considered to have a high probability of having this disease. Our goal was to evaluate the capacity of the STOP-BANG questionnaire and to compare it with the ability of a sleep trained pulmonologist in determining the probability of OSA. A retrospective analysis of 327 patients suspected of having this condition was performed. One hundred and seventy-one were males (52.3%), 49.8 years old (37.9-61.7), BMI 38.7 kg/m2 (32.5-46), neck circumference 44 cm (41-47.5), 311 snorers (95.1%), 232 with daytime sleepiness or usual tiredness (70.9%), 206 with observed apneas (63%), 169 with arterial hypertension (51.7%), normal polysomnography 42 (12.9%), mild 65 (19.9%), moderate 59 (18%), severe 161 (49.2%). The STOP-BANG's sensibility and specificity, taking as a cut-off point a respiratory disturbance index (RDI) > or = to 15, was 99.1% and 14.0% respectively, area under curve (AUC) 0.755 (0.704-0.800), the values for the PR actioner's ability were 89.1% and 58.9% respectively, AUC 0.550 (0.542-0.638). The STOP-BANG questionnaire is easy to implement as a screening tool.

STOP-BANG, una herramienta útil y sencilla para el cribado del síndrome de apneas hipopneas obstructivas del sueño / STOP-BANG, a useful and easy tool for the screening of obstructive sleep apnea

El cuestionario STOP-BANG, del acrónimo en inglés S snore (ronquido), T tired (cansancio), Oobserved apneas (apneas observadas), P pressure (hipertensión arterial), B BMI (índice de masa corporal >35 kg/m2), A age (edad > 50 años), N neck (circunferencia del cuello > 40 cm) y G gender (sexo masculino), es una herramienta sencilla que permite detectar pacientes con síndrome de apneas/ hipopneas obstructivas del sueño (SAHOS). Si el paciente suma 3 o más puntos se considera que tiene una alta probabilidad de padecerlo. El objetivo de nuestro trabajo fue evaluar la capacidad del cuestionario STOP-BANG y compararla con la habilidad del médico neumonólogo capacitado en sueño para determinar la probabilidad de tener SAHOS. Se analizaron en forma retrospectiva 327 pacientes con sospecha de esta condición. Sexo masculino 171 (52.3%), edad 49.8 (37.9-61.7) años, índice de masa corporal (IMC) 38.7 (32.5-46) kg/m², circunferencia del cuello 44 (41-47.5) cm, roncadores 311 (95.1%), con somnolencia o cansancio 232 (70.9%), con apneas observadas 206 (63%), HTA 169 (51.7%), polisomnografía (PSG) normal 42 (12.9%), leve 65 (19.9%), moderada 59 (18%) y grave 161 (49.2%). La sensibilidad y especificidad del STOP-BANG, tomando como punto de corte un índice de perturbación respiratoria (IPR) = 15, fueron 99.1% y 14.0%, área bajo la curva (ABC) 0.755 (0.704-0.800), las de la habilidad del médico fueron 89.1% y 58.9%, ABC 0.550 (0.542-0.638). El STOP-BANG es una herramienta de fácil aplicación para el cribado de pacientes con sospecha de SAHOS.

The STO-BANG questionnaire, S standing for snore, T tired, O observed apneas, P pressure (arterial hypertension), B BMI (body mass index > 35 kg/ m2), A age (> 50 years old), N neck circumference (> 40 cm), G gender (male); is a simple tool that enables the detection of patients with obstructive sleep apnea syndrome (OSA). If the patient adds 3 or more points, it is considered to have a high probability of having this disease. Our goal was to evaluate the capacity of the STOP-BANG questionnaire and to compare it with the ability of a sleep trained pulmonologist in determining the probability of OSA. A retrospective analysis of 327 patients suspected of having this condition was performed. One hundred and seventy-one were males (52.3%), 49.8 years old (37.9-61.7), BMI 38.7 kg/m² (32.5-46), neck circumference 44 cm (41-47.5), 311 snorers (95.1%), 232 with daytime sleepiness or usual tiredness (70.9%), 206 with observed apneas (63%), 169 with arterial hypertension (51.7%), normal polysomnography 42 (12.9%), mild 65 (19.9%), moderate 59 (18%), severe 161 (49.2%). The STOP-BANG´s sensibility and specificity, taking as a cut-off point a respiratory disturbance index (RDI) > or = to 15, was 99.1% and 14.0% respectively, area under curve (AUC) 0.755 (0.704-0.800), the values for the PR actioner's ability were 89.1% and 58.9% respectively, AUC 0.550 (0.542-0.638). The STOP-BANG questionnaire is easy to implement as a screening tool.