Obstructive sleep apnoea and metabolic impairment in severe obesity.

Obstructive sleep apnoea (OSA) seems to worsen metabolism. This effect has not been evaluated in morbid obesity (MO). We hypothesised that the metabolic profile is more impaired in MO patients with OSA than in those without, and investigated whether any specific metabolic dysfunction is related to OSA in MO. A prospective multicentre cross-sectional study was conducted in consecutive subjects before bariatric surgery. OSA was defined as apnoea/hypopnoea index (AHI) ≥15 by overnight polysomnography. Anthropometrical, blood pressure (BP) and fasting blood measurements were obtained the morning after. Metabolic syndrome (MetS) was defined according to National Cholesterol Education Program Adult Treatment Panel III modified criteria. 159 patients were studied: 72% were female and 72% had OSA. MetS prevalence was 70% in OSA versus 36% in non-OSA (p<0.001). As AHI severity increased, metabolic parameters progressively worsened, even in those without type 2 diabetes (DM2). AHI was independently associated with systolic and diastolic BP, triglycerides and the percentage of glycosylated haemoglobin (HbA1c) in the total sample, and with systolic BP, high-density lipoprotein cholesterol and HbA1c in those samples without DM2. OSA increased the adjusted odds ratio of having MetS by 2.8 (95% CI 1.3-6.2; p=0.009). In MO, OSA is associated with major metabolic impairment caused by higher BP and poorer lipid and glucose control, independent of central obesity or DM2.

[Lung function in the course of amyotrophic lateral sclerosis]. / Evolución de la esclerosis lateral amiotrófica a través de la función pulmonar.

We report a case of a 26 year old man who was diagnosticated of ALS. This case is a graphic example of the pulmonary function evolution through the flow-volume loop. In the first study the espirometric values were in the normal range. The Static pulmonary pressures were weackle decreased. This was the only sign of respiratory muscle impairement. Its important to study close enough the pulmonary function through the flow/volume loop, maximal respiratory pressures and maximal voluntary Ventilation in order to know the empairment rate, and also to detect intercurrent procedures as bulbar involvement, that can affect the prognosis of the disease.