Joaquín Terán Santos

Reliability of Home Respiratory Polygraphy for the Diagnosis of Sleep Apnea-Hypopnea Syndrome. Analysis of Costs

PATIENTS AND METHODS: This was a prospective study of a random sample of patients with clinically suspected SAHS in which the participants who underwent both home respiratory polygraphy and nighttime polysomnography were blinded as to the results of their first test. Costs were calculated based on a theoretical population of 1000 individuals. A t test for paired samples, the Pearson correlation coefficient, and a receiver operator characteristic curve were used for the statistical analysis. RESULTS: The study population was composed of 45 patients with a mean (SD) age of 52.3 (11) years of whom 21 (46.6%) were diagnosed with SAHS, defined by an apneahypopnea index greater than 10 in nighttime polysomnography. Comparison of the results obtained in both recordings revealed statistically significant correlations for all comparisons. The optimal cutoff in this population was a respiratory disturbance index of 13.7 or more, for which the area under the receiver operating characteristic curve was 87.5% (95% confidence interval, 74.2%-95.4%). The mean cost of home respiratory polygraphy in a patient with suspected SAHS was €69, whereas that of polysomnography was €179. CONCLUSIONS: Home respiratory polygraphy is a reliable technique for the diagnosis of SAHS. Using this technique routinely in patients suspected of SAHS will be more economical than using nighttime polysomnography. Uncertain results must be verified by nighttime polysomnography.

Resources and Delays in the Diagnosis of Sleep Apnea-Hypopnea Syndrome

Objective The demand for consultations and diagnostic studies for sleep apnea-hypopnea syndrome (SAHS) has increased, and this has led to considerable delays. We therefore need an updated evaluation of the diagnostic situation to serve as a management tool for specialists and health care administrations responsible for solving the problem. The objective of the present study was to carry out a descriptive analysis of the situation regarding the diagnosis of SAHS in Spanish hospitals. Methods We undertook a descriptive cross-sectional observational study. Public and private hospitals listed in the Ministry of Healths 2005 catalog of health care institutions were contacted, and those that routinely evaluate patients for SAHS were included in the study. The person in charge of each hospital filled in a questionnaire concerning the availability of resources and waiting periods for diagnosis. Results Of the 741 hospitals we contacted, 217 routinely evaluated patients for SAHS. In 88% of these, respiratory polygraphy (RP) (n=168) or polysomnography (PSG) (n=97) was available. The mean waiting period was 61 days for consultation and 224 days for RP. The mean number of RP devices was 0.99 per 100 000 inhabitants, while the recommended number is 3 per 100 000 inhabitants. The mean waiting period for PSG was 166 days. The mean number of PSG beds was 0.49 per 100 000 inhabitants, while the recommended number is 1 per 100 000. Conclusions We observed a marked inadequacy of resources that has led to unacceptable waiting periods. While there has been a favorable change in the situation regarding SAHS diagnosis compared to previous studies, there is still room for improvement and it is urgent that health care authorities allocate more resources to this public health problem.

Reliability of Respiratory Polygraphy for the Diagnosis of Sleep Apnea-Hypopnea Syndrome in Children

OBJECTIVE Overnight polysomnography (PSG) is the gold standard diagnostic tool for sleep apnea-hypopnea syndrome (SAHS) in children. The aim of the present study was to evaluate the usefulness of diagnostic respiratory polygraphy in children with clinically suspected SAHS referred to our sleep-disordered breathing clinic. PATIENTS AND METHODS We studied 53 children referred with clinical suspicion of SAHS; 29 (54.7%) were boys and the mean (SD) age was 6.4 (2.9) years. After a medical history was taken and a physical examination performed, patients underwent respiratory polygraphy (Edentec) simultaneously with overnight PSG in the sleep laboratory. The 2 diagnostic tools were compared using statistical analysis. RESULTS SAHS was defined by an obstructive apnea-hypopnea index (OAHI) of 3 or more in overnight PSG and a respiratory disturbance index (RDI) of 3 or more in respiratory polygraphy. The rate of diagnostic agreement was 84.9%. The difference between the mean OAHI and RDI values was not significant (0.7 +/- 5.4; P=.34). The intraclass correlation coefficient between the OAHI and RDI was 89.4 (95% confidence interval, 82.4-93.7; P< .001). When receiver operating characteristic curves were calculated for the OAHI cutoff points used for the diagnosis of SAHS (> or =1, > or =3, and > or =5), the best RDI cutoff for all 3 OAHI values considered was found to be 4.6. When age strata were considered, in children 6 years or older the best RDI cutoff for the 3 OAHI values was 2.1. In children younger than 6 years the best RDI cutoff was 3.35 for OAHI > or =1 and 5.85 for OAHI > or =3 and > or =5. CONCLUSIONS Respiratory polygraphy in the sleep laboratory is a valid method for the diagnosis of SAHS in children.

Síndrome de apneas-hipopneas durante el sueño y corazón

Las enfermedades cardiovasculares y cerebrovasculares son las mas comunes en la sociedad industrial. Los objetivos principales de este trabajo son revisar las consecuencias fisiologicas de la apnea del sueno en el sistema circulatorio y revisar los efectos del tratamiento de esta alteracion sobre las enfermedades cardiovasculares. Las apneas durante el sueno producen de forma aguda una serie de consecuencias hemodinamicas que incluyen: hipertension pulmonar y sistemica, incremento de la poscarga ventricular y disminucion del gasto cardiaco, fenomenos todos ellos resultado de la estimulacion simpatica, del arousal, de las alteraciones en la presion intratoracica y de la hipoxia e hipercapnia. De forma cronica, el sindrome de apneas-hipopneas durante el sueno (SAHS) se ha relacionado con hipertension arterial sistemica diurna, cardiopatia isquemica, insuficiencia cardiaca congestiva y respiracion de Cheyne-Stokes en el fracaso cardiaco congestivo. Se ha observado que el tratamiento con presion positiva continua (CPAP) nasal nocturna sobre la via aerea superior disminuye el numero de apneas centrales y tambien reduce los valores de presion arterial en pacientes con SAHS e hipertension arterial.

El corazón, el sueño y la respiración

El sindrome de apneas-hipopneas durante el sueno(SAHS) consiste en la aparicion de episodios recurren-tes de limitacion al paso del aire durante el sueno,como consecuencia de una alteracion anatomico-fun-cional de la via aerea superior (VAS) que conduce a sucolapso, y causa descensos de la saturacion de oxihe-moglobina (SaO

Síndrome de apneas e hipopneas durante el sueño en niños

Los trastornos respiratorios del sueno, en particular el sindrome de apneas e hipopneas durante el sueno (SAHS), son frecuentes en la poblacion infantil (su prevalencia se ha estimado en un 1-3%) y su causa mas frecuente es la hipertrofia adenoamigdalar. Estan infradiagnosticados y se asocian a importantes complicaciones, tales como alteraciones del crecimiento, alteraciones cognitivas e incluso, en casos graves, cor pulmonale. La polisomnografia nocturna es la tecnica diagnostica de eleccion para el diagnostico del SAHS en los ninos, pero en la poblacion infantil es necesario tener en cuenta una serie de consideraciones, como la edad y el entorno adecuado. Ademas, los criterios diagnosticos del SAHS para adultos no son utiles. El tratamiento de eleccion en los ninos con SAHS es la adenoamigdalectomia, que es curativa en un 70% de los casos.

Sleep Apnea-Hypopnea Syndrome and the Heart

Cardiovascular and cerebrovascular diseases are the most common diseases in industrialized societies. The main objectives of this article were to summarize the physiological effects of sleep apnea on the circulatory system and to review how treatment of this condition influences cardiovascular disease. Acute sleep apnea has a number of hemodynamic consequences, such as pulmonary and systemic hypertension, increased ventricular afterload and reduced cardiac output, all of which result from sympathetic stimulation, arousal, alterations in intrathoracic pressure, hypoxia and hypercapnia. When chronic, sleep apnea-hypopnea syndrome is associated with systemic hypertension, ischemic heart disease, congestive heart failure, and Cheyne-Stokes respiration in patients with congestive heart failure. Nocturnal treatment with continuous positive airway pressure decreases both the number of central apneic episodes and blood pressure in patients with sleep apnea-hypopnea syndrome and arterial hypertension.

Retropharyngeal liposarcoma: apropos of a case of apnoeas and hypopnoea during sleep

Abstract Liposarcomas rarely occur in the head and neck. We report a case of myxoid liposarcoma occurring in the retropharyngeal space in a middle-aged male with clinical symptoms of obstructive sleep apnoea.

NIV (Non Invasive Ventilation) criteria and Amyotrophic Lateral Sclerosis (ALS) Survival

Introduction: The aim of our study was to assess different criteria used to introduce NIV in ALS patients, including polysomnography (PSG) values and how it can affecttheir survival. Methods: We analyzed retrospectively 40 patients from the diagnosis of the disease to the beginning of NIV and their follow-up. We collected demographic parameters, respiratory function, respiratory symptoms, arterial blood gases and polysomnographic values. Results: We included 40 patients with ALS who received a respiratory assessment to evaluate the need of NIV. The mean age of diagnosis of the disease was 63 ± 11 years. Prior to the indication of NIV, 17 PSG studies were performed. Table 1 shows the characteristics of both groups: PSG versus non PSG group. Sleep efficiency was 49.9%, with a predominance of N1 (28.8%) and N2 (45.5%), a high index of arrousals (26.4 / h) and an obstructive AHI of 19 / h. The CT90 was 43.9%. Patients with bulbar onset had a survival of only 4 months versus 17 months of patients without bulbar onset. Patients who underwent PSG had longer survival than patients without PSG. Conclusions: The performance of PSG in ALS allows the evaluation of nocturnal respiratory failure parameters (CT90, AHI, ODI) and its behavior on sleep efficiency, which can serve as early criteria for initiating NIV and therefore help increase survival in these patients.

Obstructive Sleep Apnea (OSAS) in a clinical cohort of children. Atlantis Study

Aim: To evaluate the succes rate of surgical treatment and residual OSAS in a cohort of children Methods: We performed an observational, longitudinal, ambispectives study in children referred to the Sleep Unit from 2000 to 2010. In all children included, we performed a clinical history, physical and otorhinolaryngology examination and Nocturnal Polysomnography (NPSG) or Nocturnal Polygraphy (NRP). Obstructive apnea/Hypopnea index (OAHI)≥3 on NPSG and respiratory disturbances index (RDI)≥4.6 on NRP were taken as diagnosis of OSAS. Results: 1139 children were estudied, 672 boys and 467 girls. The average age was 4.85±3.07 years and the average Body Mass Index (BMI) percentile was 52.84±32.39. For the diagnosis, we used NPSG in (50.1%) and NRP in (49.9%) of children included. Snoring and respiratory pauses were reported in 85.9% and 56.9%; Hyperactivity, sleepiness and irritability were reported in 25.5%, 21.8% and 9.2%. 738 (64.8%) of children were diagnosed of OSAS, with an RDI of 9.5±12.6. There were no differences in sex between the OSAS and nonOSAS groups, but there were statistically significant differences in age, weight, neck circunference and BMI. Surgical treatment was performed in 559(75.7%) of OSAS. The success rate was 73.9%; 95% CI:69.01%-78.84% with a statiscally significant improvement in all of clinical and respiratory variables. The prevalence of residual OSAS was 26.1%. In the binary logistic regression model, age BMI, high hard palate and adenotonsillar hypertrophy emerged as a significant risk factors for OSAS. Conclusions: The persistence of disease (26.1%), in spite of treatment, it makes neccessary to follow-up and perform sleep control studies. Funded by SEPAR and FIS