A. Ferre

Neurophysiological two-channel polysomnographic device in the diagnosis of sleep apnea.

STUDY OBJECTIVE Our objective was to evaluate a portable device (Somté, Compumedics, Australia), which incorporates 2 neurophysiological channels (electroencephalography and electrooculography) with cardiorespiratory monitoring for the diagnosis of obstructive sleep apnea (OSA). METHOD Full polysomnography (PSG) and Somté recordings were simultaneously performed in 68 patients with suspected OSA. Data were analyzed blindly by 2 scorers. RESULTS A good agreement between methods in sleep efficiency was observed (68.8% [18.4] with PSG vs 68% [19.1] with Somté [p: n.s.] for scorer 1, and 67.5% [19.1] vs 68.4% [18.5; p: n.s.] for scorer 2). The apnea-hypopnea index (AHI) obtained with Somté was lower than with PSG: 19 (17.8) vs 21.7 (19) (p < 0.001) for scorer 1, and 16.6 (16.7) vs 20 (18.8) (p < 0.001) for scorer 2. The sensitivity of Somté for a PSG-AHI > 5 was 91% for scorer 1 and 90% for scorer 2, while specificity was 77% and 90%, respectively. The areas under the receiver operating curve for different PSG-AHI cutoff points (≥ 5, ≥ 15, and ≥ 30) were 0.81, 0.90, and 0.86, respectively, for scorer 1, and 0.90, 0.88, and 0.83 for scorer 2. CONCLUSIONS These data suggest that Somté is an effective device to identify sleep and respiratory variables in patients with suspected OSA.

Sleep-Related Breathing Disorders in Chiari Malformation Type 1: A Prospective Study of 90 Patients

Study objective The aim of the present study is to describe the prevalence of sleep disorders in a large group of patients with Chiari malformation type 1 (CM-1) and determine the presence of risk factors associated with these abnormalities. Methods Prospective study with consecutive patient selection. We included 90 adult patients with CM-1, defined by the presence of a cerebellar tonsillar descent (TD) ≥3 mm. Clinical, neuroradiological studies, and nocturnal polysomnography (PSG) was carried out. In addition, patients were also subclassified into 2 CM subtypes: CM-1, with the obex above the foramen magnum (FM) and CM-1.5, in which along with a TD ≥3 mm, the obex was located below the FM. Results We observed a high prevalence (50%) of sleep-related breathing disorders (SRBDs) with predominant hypopnea. Only six patients showed a central apnea index of ≥5. Hypoventilation was observed in only three patients. SRBD severity was associated with male sex, older age, excess weight, and the presence of hydrocephalus. No differences in clinical or PSG parameters were found when comparing CM subtypes (CM-1 and CM-1.5). Sleep architecture study showed decreased sleep efficiency with an increase in arousal and waking after sleep onset. The presence of SRBDs was found to be associated with poorer sleep architecture parameters. Conclusions This study confirms a high prevalence of SRBDs in patients with CM-1 and CM-1.5, with a predominant obstructive component. Nocturnal PSG recordings should be systematically conducted in these patients, especially those who are male, older, or overweight or those who present hydrocephalus.

Brainstem auditory and somatosensory evoked potentials: a methodological study to evaluate the reproducibility of two devices.

We aimed to determine whether statistical significant differences exist between the sets of results obtained from two devices used in our department for measuring brainstem auditory evoked potentials (BAEPs) and somatosensory evoked potentials (SEPs). We obtained BAEP and median and posterior tibial nerve SEP values bilaterally in ten healthy subjects. The tests were performed on the same subject using two devices consecutively. The equipment consisted of a Nicolet Viking-IV (Nicolet, Madison, WI, USA) and a Viking Select (Viasys Healthcare, Madison, WI, USA), and the same recording electrodes and stimulator (auditory and electrical) were used without modifying any postural position of the subject. The stimuli and recording parameters were the same for both devices. We obtained 20 sets of data for each type of test. The Bland–Altman plots as well as the one-sample t-test or Wilcoxon signed rank test were used to compare data between the two groups of data sets. We found no significant differences between the sets of values obtained with the two devices. Our analysis indicates that the two devices are equal in recording all different variables of BAEP and SEP, which allows us to combine the BAEP and SEP data obtained from the two devices for follow-up studies involving quantitative statistical methods. This study received institutional approval (protocol number PRAG-154/2013).

Obstructive sleep apnea and silent cerebral infarction in hypertensive individuals

Obstructive sleep apnea syndrome is very prevalent in hypertensive subjects. Moreover, obstructive sleep apnea syndrome activates multiple processes that might be associated with silent cerebral infarct independently of established risk factors. Our aim is to estimate the frequency of obstructive sleep apnea syndrome in hypertensive patients with and without silent cerebral infarct, and to determine whether obstructive sleep apnea syndrome is an independent risk factor of silent cerebral infarct and/or lacunar silent cerebral infarct in patients with hypertension. In this matched cross‐sectional study performed in hypertensive subjects, each patient with silent cerebral infarct detected by magnetic resonance imaging was matched with two patients without silent cerebral infarct. Polysomnographic studies were performed, and the apnea–hypopnea index was calculated. Severe obstructive sleep apnea syndrome was considered in those with apnea–hypopnea index >30. One‐hundred and eighty‐three patients, 61 with silent cerebral infarct and 122 without silent cerebral infarct, were evaluated. The mean age was 64.1 ± 4.5 years, and 72.1% were men. The frequency of severe obstructive sleep apnea syndrome was 44.3% in patients with silent cerebral infarct and 38.5% in the control group. An adjusted conditional logistic regression model did not show a significant increased risk of silent cerebral infarct in patients with severe obstructive sleep apnea syndrome (odds ratio 1.362; 95% confidence interval: 0.659–2.813; P = 0.404). Forty‐three patients (70.5%) of the silent cerebral infarct were lacunar. The presence of severe obstructive sleep apnea syndrome was significantly higher in lacunar silent cerebral infarct when compared with patients without lacunar infarcts (55.8% versus 35.7%, P = 0.019), being independently associated on an adjusted logistic regression model (odds ratio 2.177; 95% confidence interval: 1.058–4.479; P = 0.035). In conclusion, severe obstructive sleep apnea syndrome is highly prevalent among hypertensive subjects, and is independently associated with lacunar silent cerebral infarct.

Poor self-reported sleep quality and health-related quality of life in patients with chronic fatigue syndrome/myalgic encephalomyelitis

Non‐restorative sleep is a hallmark symptom of chronic fatigue syndrome/myalgic encephalomyelitis. However, little is known about self‐reported sleep disturbances in these subjects. This study aimed to assess the self‐reported sleep quality and its impact on quality of life in a Spanish community‐based chronic fatigue syndrome/myalgic encephalomyelitis cohort. A prospective cross‐sectional cohort study was conducted in 1,455 Spanish chronic fatigue syndrome/myalgic encephalomyelitis patients. Sleep quality, fatigue, pain, functional capacity impairment, psychopathological status, anxiety/depression and health‐related quality of life were assessed using validated subjective measures. The frequencies of muscular, cognitive, neurological, autonomic and immunological symptom clusters were above 80%. High scores were recorded for pain, fatigue, psychopathological status, anxiety/depression, and low scores for functional capacity and quality of life, all of which correlated significantly (all p < 0.01) with quality of sleep as measured by the Pittsburgh Sleep Quality Index. Multivariate regression analysis showed that after adjusting for age and gender, the pain intensity (odds ratio, 1.11; p <0.05), psychopathological status (odds ratio, 1.85; p < 0.001), fibromyalgia (odds ratio, 1.39; p < 0.05), severe autonomic dysfunction (odds ratio, 1.72; p < 0.05), poor functional capacity (odds ratio, 0.98; p < 0.05) and quality of life (odds ratio, 0.96; both p < 0.001) were significantly associated with poor sleep quality. These findings suggest that this large chronic fatigue syndrome/myalgic encephalomyelitis sample presents poor sleep quality, as assessed by the Pittsburgh Sleep Quality Index, and that this poor sleep quality is associated with many aspects of quality of life.

Software de los dispositivos de servoventilación adaptativa para la evaluación de los episodios respiratorios residuales de pacientes con apneas centrales o complejas

negative, and we empirically started antibiotic treatment with tazobactam/piperacillin. A chest X-ray performed on day 4after admission revealed slight improvement of the abscess (Fig. 1B), but hemoptysis developed 1 week later. Contrast-enhanced chest computed tomography (CT) revealed an enhanced nodule inside the abscess (Fig. 1C), suggesting PAP. The next day, because of continued hemoptysis and progressive respiratory failure, embolization of the pulmonary artery at the right A5 portion was performed with 2Interlock ® detachable coils (Boston Scientific Corp), 4Hilal ®

30. Sleep apnea syndrome in infants with gastro esophageal reflux

very difficult as gold standard tests are not available. Objective: To determine the usefulness of single fiber electromyography by axonal stimulation (SFEMG-AS) in orbicularis oculi muscle in OMG. Patients and methods: We studied 142 patients with suspected diagnosis of OMG (female: 96, male: 46; age range: 10–87). The diagnosis of OMG was based on historical, clinical, pharmacological, neurophysiological and immunological findings, following international diagnosis criteria. Then, they were categorized according to Osserman classification in types I and IIa and correlated to the electrophysiological findings. Results: The clinical presentations observed were type I (20 patients), type IIa (38 patients), with atypical symptoms (20 patients) and other, non-myasthenia conditions (64 patients). In OMG I sensitivity was 65% and specificity was 97.5%. In OMG IIa, sensitivity was 94.3% and specificity was 98.7% (CI: 95%). Conclusions: SFEMG-AS is a very sensitive electrophysiological tool, detecting abnormalities in neuromuscular transmission in OMG patients with an excellent clinical correlation.