Bernabé Jurado Gámez

Coste-eficiencia y grado de satisfacción de la poligrafía domiciliaria en pacientes con síntomas de apnea del sueño

Objetivo: Comparar la validez diagn?stica, el grado de satisfacci?n del paciente y el coste econ?mico de la poligraf?a domiciliaria respecto a la polisomnograf?a convencional. Pacientes y m?todos: Se seleccion? consecutivamente a pacientes con s?ntomas indicativos de s?ndrome de apneas-hipopneas durante el sue?o (SAHS). Analizamos la rentabilidad de la poligraf?a domiciliaria mediante el ?ndice apneas-hipopneas (IAH), el ?ndice de desaturaci?n igual o mayor del 3% y el porcentaje de tiempo con una saturaci?n arterial de ox?geno menor del 90%. Se compararon el grado de satisfacci?n del paciente, evaluada con una escala visual, y el coste de la poligraf?a respecto a la polisomnograf?a. Resultados: Se incluy? en el estudio a 52 pacientes (42 varones y 10 mujeres) con una edad media ? desviaci?n est?ndar de 51,8 ? 9 a?os e ?ndice de masa corporal de 32 ? 5 kg/m2. La polisomnograf?a y la poligraf?a obtuvieron un IAH de 33,6 ? 20 y de 31 ? 19, respectivamente (r = 0,971; coeficiente de correlaci?n intraclase = 0,963; p < 0,001). Los valores del ?ndice de desaturaci?n igual o mayor del 3% y el porcentaje de tiempo con una saturaci?n arterial de ox?geno menor del 90% mostraron una correlaci?n y concordancia significativas (p < 0,05). Para un IAH obtenido en la polisomnograf?a de 10, la poligraf?a mostr? una sensibilidad del 89% y una especificidad del 80%, con un ?rea bajo la curva de eficacia diagn?stica de 0,804; en el SAHS grave (IAH ? 30) la sensibilidad y especificidad de la poligraf?a fue del 100% (?rea bajo la curva de eficacia diagn?stica = 1). En la poligraf?a, el coste por prueba diagn?stica fue 101,34 ? menor que en la polisomnograf?a, y el grado de satisfacci?n del paciente, significativamente mayor (p < 0,0001). Conclusiones: La poligraf?a domiciliaria es una t?cnica diagn?stica v?lida y coste-eficiente, que aporta mayor grado de satisfacci?n que la polisomnograf?a convencional al paciente con s?ntomas de SAHS.

Intervención domiciliaria y variables predictoras para reingreso hospitalario en la enfermedad pulmonar obstructiva crónica agudizada

BACKGROUND Chronic obstructive pulmonary disease (COPD) exacerbation increases mortality and resources used associated with hospitalization. We studied whether early home monitoring reduces the rate of readmission and if there are any predictor variables. PATIENTS AND METHODS We performed a prospective, controlled, parallel-group study in patients who were hospitalized for COPD. Patients whose residence was within less than 15km from the hospital were assigned to an interventional group (home visits by nurses about 48-72hours after discharge), the remainder were assigned to a conventional care group. The rate of rehospitalization within the first month was compared between the two groups, as well as those variables that showed a predictive capability. RESULTS Seventy one patients were included: 35 in the conventional care group and 36 in the interventional group. In the latter, the treatment was modified in 13 patients (36%). The hospital readmission rate was 17%, which was similar in both groups (P=.50). For every 5-year increase in age, the risk for readmission was 2.54 (95%CI, 1.06-5.07) and for each increase of 10mmHg in PaCO(2), the risk of readmission was 8.34 (95%CI, 2.43-18.55). CONCLUSIONS Early home monitoring did not decrease the readmission rate during the first month. Older age and high PaCO(2) are factors that identify the group with a high risk for rehospitalization.

Sleep Disorders in Patients on a Kidney Transplant Waiting List

OBJECTIVE To evaluate the prevalence of sleep disorders in patients awaiting kidney transplants compared to a control group. PATIENTS AND METHODS We carried out an observational study of 23 patients on a kidney transplant waiting list in comparison with 20 healthy volunteers matched for age, sex, and body mass index (BMI). Overnight polysomnography was performed and a diagnosis of sleep apnea-hypopnea syndrome (SAHS) established when the apnea-hypopnea index (AHI) was 10 or higher. RESULTS Eighty-two percent of the patients awaiting kidney transplants (16 men and 7 women with a mean [SD] age of 51 [15] years and a mean BMI of 25 [3.8] kg/m2) had some type of sleep disorder. The most frequent disorders were SAHS (48%) and insomnia and periodic limb movement disorder (30%). Patients showed poorer sleep efficiency compared to the control group (75.4% vs 87.8%; P=.01) and a lower percentage of slow-wave and rapid eye movement sleep (24.5% vs 40%; P=.001). Those with sleep-disordered breathing had a higher AHI (17.7 vs 3.6; P=.001) and oxygen desaturation index (31.5 compared to 8.2; P=.001). CONCLUSIONS Sleep disorders are common in patients awaiting kidney transplants. Such patients show reduced quantity and quality of sleep compared to controls and a significantly elevated number of respiratory events that may affect morbidity and mortality.

Cost–Effectiveness and Degree of Satisfaction With Home Sleep Monitoring in Patients With Symptoms of Sleep Apnea

Objetive To assess the diagnostic validity, degree of patient satisfaction, and economic cost of home sleep monitoring compared to conventional polysomnography. Patients and methods Consecutive patients with symptoms indicative of sleep apnea-hypopnea syndrome (SAHS) were included. We analyzed the diagnostic yield of home sleep monitoring using the apnea–hypopnea index (AHI), number of desaturations of at least 3%, and the percentage time with arterial oxygen saturation below 90%. The degree of patient satisfaction, measured on a visual analogue scale, and the cost of home monitoring were compared with conventional polysomnography. Results The study included 52 patients (42 men and 10 women) with a mean (SD) age of 51.8 (9) years and a body mass index of 32 (5) kg/2. Polysomnography and home monitoring revealed an AHI of 33.6 (20) and 31 (19), respectively (r=0.971; intraclass correlation coefficient = 0.963; P Conclusions Home sleep monitoring is a valid and cost-effective diagnostic test; patients with symptoms of SAHS are more satisfied with this technique than conventional polysomnography.

Variación de la expresión proteica en función de la gravedad del síndrome de apnea-hipopnea del sueño

OBJECTIVE A prospective study with a consecutive sample and a control group to determine whether protein expression in patients with sleep apnoea-hypopnoea syndrome (SAHS) is different from that of the control group (IAH < or =5). PATIENTS AND METHODS A total of 32 patients aged between 35 and 60 years who had a polysomnograph performed were included. Patients with an acute or chronic were excluded. The first dimension of the proteomic study was carried out on IPG strips (18cm, pH 4-7) and the second on SDS-PAGE gels in triplicate for each group. The gels were stained with SYPRO-Ruby (Bio-Rad((R))), the images obtained with an FX-Imager laser scanner and the spots were analysed using ProteomWeaver v. 4.0 (Bio-Rad((R))) software. Significant changes between the gels were analysed by replicates and separately, being considered a significant change if the relative intensity of the spots was three times higher or lower than that of the control and if it was observed in 2 of the 3 replicates of each group, with a coefficient of variation of <20%. RESULTS The patients were divided into 8 subjects per group (control, mild, moderate and severe). The comparison of the gels showed significant differences between the control group and the 3 clinical groups, with significant over-expression being observed in 3 spots, and under-expression in 7 spots in the control group. CONCLUSION There are significant changes in protein expression between a control group and patients in different stages of disease. The proteomic study can identify biomarkers associated with the diagnosis and severity of the SAHS.

Variation in Protein Expression Depending on the Severity of Sleep Apnoea-Hypopnoea Syndrome

Abstract Objective A prospective study with a consecutive sample and a control group to determine whether protein expression in patients with sleep apnoea-hypopnoea syndrome (SAHS) is different from that of the control group (IAH ≤ 5). Patients and methods A total of 32 patients aged between 35 and 60 years who had a polysomnograph performed were included. Patients with an acute or chronic disease were excluded. The first dimension of the proteomic study was carried out on IPG strips (18 cm, pH4–7) and the second on SDS-PAGE gels in triplicate for each group. The gels were stained with SYPRO-Ruby (Bio-Rad®), the images obtained with an FX-Imager laser scanner and the spots were analysed using ProteomWeaver v.4.0 (Bio-Rad®) software. Significant changes between the gels were analysed by replicates and separately, being considered a significant change if the relative intensity of the spots was three times higher or lower than that of the control and if it was observed in 2 of the 3 replicates of each group, with a coefficient of variation of Results The patients were divided into 8 subjects per group (control, mild, moderate and severe). The comparison of the gels showed significant differences between the control group and the 3 clinical groups, with significant over-expression being observed in 3 spots, and under-expression in 7 spots in the control group. Conclusion There are significant changes in protein expression between a control group and patients in different stages of disease. The proteomic study can identify biomarkers associated with the diagnosis and severity of the SAHS.

Valor del análisis cardiorrespiratorio en el diagnóstico de los trastornos respiratorios del sueño en pacientes con insuficiencia renal crónica

BACKGROUND AND OBJECTIVE: Prevalence of sleep apnea-hypopnea syndrome (SAHS) in end-stage renal disease (ESRD) is high and the polygraphy has not been validated as diagnostic technique in this group of patients. The objective of this study was to evaluate if only the cardiorespiratory analysis is valid for the diagnosis of SAHS. PATIENTS AND METHOD: 48 patients with ESRD were studied consecutively with all-night polysomnography. We compared the desaturation index of SaO2 > or = 4% (DI4), sleep time spent with SaO2 < 90% (T90) and the apnea-hypopnea index (AHI) per hour of sleep with the results of the cardiorespiratory analysis. RESULTS: We included 35 men and 13 women, age: 54 (16) years and IMC: 27.1. Eighteen patients were diagnosed of SAHS (37.5%). The cardiorespiratory analysis obtained a sensibility of 77.7%, specifity of 100%, positive predictive value was 100% and negative predictive was 88%. The polysomnography showed an AHI: 16 (17.2), while the cardiorespiratory analysis was 11 (13.2). There were a good correlation (r = 0.970) and concordance scores (CCI = 0.967; p < 0.001). The cardiorespiratory analysis, respect the polysomnography, also obtained a good correlation and concordance for ID4 (10 [11.8] vs 15 [15.5]) and for T90 (1 [2.9] vs 2 [4.7]; p < 0.001). In the COR curve, the best cut-off point of the cardiorespiratory analysis was an AIH = 7.2. CONCLUSIONS: In patients with ESRD, the cardiorespiratory analysis, is valid for the diagnosis and correctly detect the SaO2 at night, both being key parameters for the diagnostic and treatment of SAHS. The polygraphy could be an alternative diagnostic test in the SAHS, although it has to be definitively validated.