[Variability of cardiac rate in patients with obstructive sleep apnea/hypopnea]. / Variabilitatea frecventei cardiace la pacientii cu sindrom de apnee/hipopnee obstructiva în somn.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated breathing pauses caused by upper airway collapse during sleep, leading to intermittent hypoxemia, sleep fragmentation and autonomic dysfunction. The gold standard for the treatment of OSAHS is ventilation with continuous positive airway pressure (CPAP). AIM: To study the effect of CPAP on autonomic dysfunction in patients OSAHS, by assessing the heart rate variability (HRV) parameters before the initiation of CPAP and under CPAP during the first week and at 3 months. MATERIAL, METHODS: We have assessed HRV parametrs by 24 hours ECG Holter monitoring in 42 patients with moderate and severe OSAHS (apnea-hypopnea index AHI > or = 15/h) without other causes of autonomic neuropathy. The assessment was made at diagnosis, during the first week of CPAP use and at 3 months of CPAP use. RESULTS. Both time domain and frequency domain HRV parameters decreased significantly during the first week of CPAP use and increased back to normal values at 3 months. Initially and during the first week of treatment, HRV parameters correlated negatively with the severity of OSAHS expressed by AHI. CONCLUSIONS: Patients with OSAHS present an alteration of HRV, proportionally with disease severity. The decrease in HRV is revealed by the absence of apneas during the initiation of CPAP. After 3 months of CPAP treatment, the HRV parmeters are normalized independently of the disease severity.

Body composition in obstructive sleep apneahypopnea syndrome bio-impedance reflects the severity of sleep apnea.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated breathing pauses during sleep and is closely associated with obesity. Body fat is known to be a predictive factor for OSAHS and its severity. AIM: To study the correlation between the severity of OSAHS and body composition measurements. METHODS: 30 patients with OSAHS (21 men, 9 women, mean age 45.1 years, mean apnea-hypopnea index = 29.6/hour) were included in the study after full polysomnography. They were divided into 3 groups according to the apnea-hypopnea index (AHI): mild OSAHS (mean AHI 10.9/h), moderate OSAHS (mean AHI 23.9/h) and severe OSAHS (mean AHI 53.9/h). Body composition (body fat, body water and dry lean mass) was assessed using bioelectric impedance assay (BIA). Other measurements included neck and abdominal circumferences and body mass index (BMI). Pearson's coefficient (r) was used to express correlations between AHI and the following parameters: BMI, neck and abdominal circumferences, body fat, dry lean mass, and body water. Wilcoxon Sum-of-Ranks (Mann-Whitney) test for comparing unmatched samples was used to compare anthropometric and body composition measurements between groups. RESULTS: The correlation between AHI and BMI was weak (r = 0.38). AHI correlated moderately with neck circumference (r = 0.54), with neck circumference corrected by height (r = 0.60), and more strongly with body fat (r = 0.67), with body water (r = 0.69) and with abdominal circumference (r = 0.75). There was a strong negative correlation between AHI and dry lean mass (r = - 0.92). There were significant differences in body fat, body water, neck circumference corrected by height and abdominal circumference (Wilcoxon Sum-of-Ranks, p < 0.01), between mild and severe OSASH groups, but not in BMI (Wilcoxon Sumof-Ranks, W = 86.5; p = 0.17). CONCLUSIONS: In our study, the severity of OSAHS correlated with body fat and with body water more strongly than with general and cervical obesity. Abdominal adiposity may predict OSAHS severity better than neck circumference.

[Pre-test probability of obstructive sleep apnea]. / Probabilitatea pre-test pentru sindromul de apnee obstructiva in somn.

The obstructive sleep apnea syndrome (OSAS) is a condition characterized by repeated breathing pauses during sleep and associated with sleep fragmentation, intermittent hypoxia and increased, cardiovascular risk. The diagnosis of OSAS requires polysomnography, an expensive and time consuming technique, which still represents the gold-standard method. Several predictive mathematical models have been developed for the prediction of OSAS. These models combine subjective parameters (such as sleepiness, witnessed apneas and snoring), morphometric data (body mass index, neck circumference and cephalometric measures), associated co morbidities (such as hypertension), and oximetry data.

[Physiologic responses to walking and cycling in patients with chronic bronchial obstruction]. / Raspunsuri fiziologice la mers si pedalare la pacentii cu obstructie bronsica.

INTRODUCTION: In patients with bronchial obstruction, desaturation is more important during walking than cycling. For other effort parameters, studies report conflicting data. OBJECTIVE: Comparing different responses (desaturation, tachycardia, tachypnea, dyspnea) to the 6 minutes walking test (WT6) and to cycling at 25 watts for 10 minutes (CT) in patients with COPD or asthma and assessing the correlation between these responses and functional parameters at rest. MATERIAL, METHODS: 15 patients with moderate to severe COPD (FEVI = 49,8 +/- 16%) and 13 patients with stable occupational asthma (FEVI = 75,5 +/- 26%) were evaluated by: resting spyrogram, the Saint George Respiratory Questionnaire, dyspnea (the MMRC scale), the Dijon activity score, WT6 and CT with monitoring of the arterial oxygen saturation and of the heart rate (PulsiQuant-ENVITEC-Wismar oxymeter) and with the assessment of effort-induced dyspnea using the modified Borg scale. During the 2 exercise tests, pulsoxymetry, thoracic movements and nasal airflow were concomitantly assessed using a portable cardio-respiratory polygraph (Stardust-Respironics). RESULTS: Walking distance correlated moderately with spyrographic parameters (r = 0,54 for FEV1), strongly with the Dijon activity score (r = 0,75) and there was a strong negative correlation with the acute Borg dyspnea (r = -0,83) and with the chronic MMRC dyspnea (r = -0,71). The mean and the minimum saturations were lower for the WT6 than for the CT (p = 0,019 and p<0,01, respectively). The mean and the maximal heart rates were lower for the CT than for the WT6 (p = 0,021 andp = 0,024, respectively). The acute Borg dyspnea was higher during walking than cycling (p

[Preoperative rehabilitation in the surgical treatment of lung cancer]. / Recuperarea respiratorie preoperatorie în chirurgia cancerului bronhopulmonar.

OBJECTIVE: The aim of this study is to evaluate the effect of preoperative rehabilitation on operability and postoperative outcome in patients with lung cancer. METHODS: We studied retrospectively 27 patients who underwent respiratory rehabilitation for 4 weeks prior to lung cancer resection and 26 patients who were operated without previous rehabilitation (control group). Spirometry, arterial blood gases, and exercise tests with maximum oxygen consumption (VO2max) were assessed pre and postoperatively. Postoperative outcome was evaluated in terms of complications and survival. RESULTS: Patients in the rehabilitation group had a more severe functional impairment (forced expiratory volume in 1 second FEV1 67,9% versus 79,3% and VO2max 60% versus 85,7% in the control group). The rehabilitation program increased FEV1 and VO2max by 4,3% and 8%, respectively, in patients who had had these parameters below 60%. Postoperative complications and survival were similar between the 2 groups. CONCLUSIONS: Preoperative rehabilitation is beneficial in patients with borderline respiratory function, improving accessibility to intervention.

[Respiratory manifestations in von Recklinghausen's disease]. / Manifestairi respiratorii in boala von Recklinghausen.

The neurofibromatosis type I (NF I, von Recklinghausen's disease) is an autosomal dominant neurocutaneous disorder with systemic involvement. The respiratory manifestations include: chest wall deformities, upper airway obstruction by neurofibromas, parenchymal neurogenic tumours, pulmonary fibrosis, cystic lung disease, primary pulmonary hypertension, central hypoventilation, diaphragm paralysis. We present 4 cases of NF I associated with chronic respiratory diseases. The common feature is the presence of severe chest deformities. The bullous emphysema was present in 2 of them. All 4 patients suffered from depressive syndrome with neuroleptic use.