Félix del Campo Matías

Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences

Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two diseases that often coexist within an individual. This coexistence is known as overlap syndrome and is the result of chance rather than a pathophysiological link. Although there are claims of a very high incidence of OSAS in COPD patients, recent studies report that it is similar to the general population. Overlap patients present sleep-disordered breathing associated to upper and lower airway obstruction and a reduction in respiratory drive. These patients present unique characteristics, which set them apart from either COPD or OSAS patients. COPD and OSAS are independent risk factors for cardiovascular events and their coexistence in overlap syndrome probably increases this risk. The mechanisms underlying cardiovascular risk are still unclear, but may involve systemic inflammation, endothelial dysfunction, and tonic elevation of sympathetic neural activity. The treatment of choice for overlap syndrome in stable patients is CPAP with supplemental oxygen for correction of upper airway obstructive episodes and hypoxemia during sleep.

Insuficiencia respiratoria aguda en el postoperatorio inmediato de cirugía por obesidad mórbida

Los pacientes con sindrome de apneas-hipopneas durante el sueno tienen una mayor probabilidad de presentar mas complicaciones postoperatorias. La utilizacion precoz de tratamiento con presion positiva continua de la via aerea puede evitar su aparicion. Se presenta el caso de un paciente intervenido de obesidad morbida que desarrollo, en el postoperatorio inmediato, un cuadro de insuficiencia respiratoria aguda, que preciso el reingreso en la unidad de reanimacion y evoluciono favorablemente tras la instauracion de tratamiento con presion positiva con 2 niveles de presion. Posteriormente se confirmo que presentaba sindrome de apneas-hipopneas durante el sueno.

Obstructive Sleep Apnoea Syndrome as a Systemic Low-Grade Inflammatory Disorder

Though clinically recognized for more than four decades (Gastaut et al., 1965), general awareness of OSAS has been slow to develop. OSAS has been associated with cardiovascular disease (Marin et al., 2005; Duran-Cantolla et al., 2010; Barbe et al., 2010), automobile accidents (Teran-Santos et al., 1999), chronic obstructive pulmonary disease (Chaouat et al., 1995), heart failure (Oldenburg et al., 2007) and health related quality of life deterioration (Pichel et al., 2004). OSAS often coexists with obesity and has been related to insulin resistance and metabolic syndrome (Choi et al., 2008).

Upper Airway Resistance Syndrome - A Twenty-Five Years Experience

Felix del Campo Matias1, Tomas Ruiz Albi2 and Carlos Zamarron Sanz3 1Division of Respiratory Medicine, Hospital Universitario Rio Hortega, Departament of Medicine, Universidad de Valladolid,Valladolid 2Division of Respiratory Medicine, Hospital Universitario Rio Hortega, Valladolid, 3Division of Respiratory Medicine Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain

Acute Respiratory Failure Immediately Following Surgery for Morbid Obesity

Patients with sleep apnea-hypopnea syndrome have a higher probability of presenting more postoperative complications, yet early treatment with continuous positive airway pressure can prevent them. We report the case of a patient who underwent surgery for morbid obesity and who developed acute respiratory failure in the immediate postoperative period, requiring readmission to the recovery unit. The patients condition progressed favorably following treatment with bilevel positive airway pressure. It was subsequently confirmed that the patient suffered from sleep apnea-hypopnea syndrome.

Accidentes laborales, absentismo y productividad en pacientes con apneas del sueño. ¿Futuro condicionante del puesto de trabajo?

Current scientific evidence shows that obstructive sleep apnea–hypopnea syndrome (OSAHS) impacts negatively on most aspects of sufferers’ daily lives, in both the short and long term. Its association with cardiovascular and metabolic diseases, relationship with impaired cognitive function and its impact on accident rates, particularly traffic accidents, have been widely described in the literature. The effects of OSAHS may lead to poorer quality of life, decreased motivation to maintain a healthy lifestyle, and possible lower compliance with treatment for comorbid conditions.1 Despite the economic repercussions, however, the effects of OSAHS in the workplace have not been studied in depth.2–4 The consequences of OSAHS on widely varying aspects of working life have been reported: temporary sick leave, disability assessments, diminished productivity, stress, dissatisfaction in the workplace, burn-out, and the risk of workplace accidents.2,5 Although not all studies are consistent in their conclusions, OSAHS patients have been found to be less efficient in their work and are more likely to suffer a work-related accident. The magnitude of the problem is underlined in a prospective Finnish study, which estimated that OSAHS could double the risk of absenteeism in both women and men.6 Jurado-Gamez et al.7 recently found that patients with OSAHS took more sick leave periods of longer than 30 days and had a higher level of psychological distress, although there was no evidence of more workplace accidents.