João Valença

Obstructive sleep apnoea syndrome as a cause of road traffic accidents

UNLABELLED Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS) patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not. METHODS We studied 163 patients with OSAS (apnoea- hypopnoea index (AHI)>10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO2 and PaCO2, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO2, % of time with SaO2 < 90% (T90), desaturation index (ODI), total duration of apnoea-hypopnoea (TDAH) (T test). RESULTS Group I (no road traffic accidents) No=89 patients; group II (road traffic accidents) No=74 patients. Age (years) was 57.6+/-11.8 vs. 54.7+/-10.9 (ns); male gender, 75% vs. 78.4%; ESS, 12.3+/-5.4 vs. 17.6+/-4.3 (p<0.001); BMI, (Kg/m2) 36.2+/-8.1 vs. 35.6+/-6.3 (ns); PaO2 (mmHg), 76.1+/-11.4 vs. 78.5+/-12.6 (ns); PaCO2 (mmHg), 42.6+/-5.1 vs. 42.2+/-4.7 (ns); FOSQ, 15.1+/-3.1 vs. 12.9+/-3.4 (p<0.001). NPSG data revealed differences only in AHI: 45.0+/-21.6 vs. 56.2+/-29.7 (p=0.01) and in TDAH (minutes), 98.5+/-63.7 vs. 133.3+/-83.2 (p=0,005). CONCLUSIONS In our experience patients who had road traffic accidents and/or near misses had a more severe OSAS, with higher AHI, excessive daytime sleepiness and lower quality of life.

The importance of completing the hipoxic challenge test in assessing the risk of altitude in air travel: Experience of flight fitness evaluation

The atmospheric pressure in cabin of the pressurized commercial aircraft is not equivalent to the pressure at sea level. If this hypobaric environment doesn9t trigger symptoms in most of people, the same is not true for patients with respiratory disease. Since the increase of air travel and the need to advice the patients to this particular setting, British Thoracic Society (BTS) have published recommendations to evaluate and prescript supplemental oxygen in these conditions. The present study describes 2 years9 experience in advice respiratory patients on flight fitness in Hospital Santa Maria. During this period, 64 patients were evaluated (54% men, mean age 46±21 years) and underwent Hypoxic Challenge Test (HCT) with a protocol in agreement with BTS guidelines. Relatively to diagnosis, 46% had cystic fibrosis, 18% chronic obstructive pulmonary disease, 12% intersticial lung disease, 7% thoracic neoplasm, 7% bronchiectasis and 3% had obstructive sleep apnoea. Six of these patients had respiratory failure and were on long-term oxygen therapy (LTOT). At baseline, 60% of patients had SpO 2 > 95%, 31% between 92-95% and 9% 2 >95% maintained their PaO 2 >55 mmHg. Twelve patients with a sea level SpO 2 between 92-95% desaturated to PaO 2 Supplemental oxygen therapy was prescribed to 31 patients and in the 6 patients on LTOT the debit was measured and increased in all of them. In conclusion, despite the recommendations indicate only the HCT for patients with SpO 2

Tuberculose primária da mama: A propósito de um caso clinico

Resumo A tuberculose mamaria e uma doenca rara. Neste contexto, os autores apresentam o caso clinico de uma doente de 64 anos, cuja mamografia de rotina revelou nodulo na mama direita que levou a investigacao etiologica. Atraves dos exames complementares efectuados nao foi possivel fazer o diagnostico diferencial entre carcinoma da mama e lesao granulomatosa, tendo-se decidido iniciar terapeutica antibacilar, com a informacao do resultado histologico de puncao aspirativa do nodulo, sugestiva de tuberculose da mama. Na avaliacao clinico-laboratorial, nao se encontrou outro foco de infeccao de tuberculose. A evolucao imagiologica foi favoravel, pelo que a doente prosseguiu o tratamento. Os autores salientam a baixa incidencia da tuberculose primaria da mama e fazem uma breve referencia a esta patologia, cuja percentagem de identificacao microbiologica e anatomopatologica e reduzida.