[Variation in protein expression depending on the severity of sleep apnoea-hypopnoea syndrome]. / Variación de la expresión proteica en función de la gravedad del síndrome de apnea-hipopnea del sueño.

OBJECTIVE: A prospective study with a consecutive sample and a control group to determine whether protein expression in patients with sleep apnoea-hypopnoea syndrome (SAHS) is different from that of the control group (IAH < or =5). PATIENTS AND METHODS: A total of 32 patients aged between 35 and 60 years who had a polysomnograph performed were included. Patients with an acute or chronic were excluded. The first dimension of the proteomic study was carried out on IPG strips (18cm, pH 4-7) and the second on SDS-PAGE gels in triplicate for each group. The gels were stained with SYPRO-Ruby (Bio-Rad((R))), the images obtained with an FX-Imager laser scanner and the spots were analysed using ProteomWeaver v. 4.0 (Bio-Rad((R))) software. Significant changes between the gels were analysed by replicates and separately, being considered a significant change if the relative intensity of the spots was three times higher or lower than that of the control and if it was observed in 2 of the 3 replicates of each group, with a coefficient of variation of <20%. RESULTS: The patients were divided into 8 subjects per group (control, mild, moderate and severe). The comparison of the gels showed significant differences between the control group and the 3 clinical groups, with significant over-expression being observed in 3 spots, and under-expression in 7 spots in the control group. CONCLUSION: There are significant changes in protein expression between a control group and patients in different stages of disease. The proteomic study can identify biomarkers associated with the diagnosis and severity of the SAHS.

Kidney transplantation improves sleep-related breathing in hemodialysis patients.

AIMS: To assess whether kidney transplantation improves sleep-related breathing disorders associated with hemodialysis. METHODS: A prospective study was carried out using full-night polysomnography. Nine hemodialysis patients (7 men and 2 women, aged 42 +/- 16.2 years, BMI 26 +/- 3.7) who later received a successful kidney transplantation were evaluated. Main sleep quality and respiratory variables were recorded: number of dips in oxygen saturation (SaO(2)) > or =3% per hour of sleep; percentage of sleep time with SaO(2) <90%; percentage of sleep time in apnea and hypopnea, and sleep apnea/hypopnea index (AHI). RESULTS: After kidney transplantation, the AHI improved in 8 of the 9 patients (10 +/- 10.7 vs. 4.9 +/- 6.1, p = 0.029). A decrease in the percentage of sleep time in apnea/hypopnea (5 +/- 6.8 vs. 0.7 +/- 1.1%, p = 0.008) and a reduction in the number of desaturations (25 +/- 26 vs. 12 +/- 11.2%, p = 0.010) were observed. CONCLUSIONS: Kidney transplantation improved respiratory events and nocturnal SaO(2) in hemodialysis patients.

[Cost-effectiveness and degree of satisfaction with home sleep monitoring in patients with symptoms of sleep apnea]. / Coste-eficiencia y grado de satisfacción de la poligrafía domiciliaria en pacientes con síntomas de apnea del sueño.

OBJECTIVE: To assess the diagnostic validity, degree of patient satisfaction, and economic cost of home sleep monitoring compared to conventional polysomnography. PATIENTS AND METHODS: Consecutive patients with symptoms indicative of sleep apnea-hypopnea syndrome (SAHS) were included. We analyzed the diagnostic yield of home sleep monitoring using the apnea-hypopnea index (AHI), number of desaturations of at least 3%, and the percentage time with arterial oxygen saturation below 90%. The degree of patient satisfaction, measured on a visual analogue scale, and the cost of home monitoring were compared with conventional polysomnography. RESULTS: The study included 52 patients (42 men and 10 women) with a mean (SD) age of 51.8 (9) years and a body mass index of 32 (5) kg/m2. Polysomnography and home monitoring revealed an AHI of 33.6 (20) and 31 (19), respectively (r=0.971; intraclass correlation coefficient = 0.963; P< .001). The number of desaturations of at least 3% and the percentage time with arterial oxygen saturation below 90% showed significant correlation and concordance (P< .05). For an AHI cutoff of 10 recorded with polysomnography, home monitoring had a sensitivity of 89% and a specificity of 80%, with an area under the receiver operator characteristic curve of 0.804. For severe SAHS (AHI> or =30), the sensitivity and specificity of home monitoring was 100% (that is, the area under the receiver operating characteristic curve was 1). For home monitoring, the cost per diagnostic test was 101.34 euro less than that of polysomnography, and the patient satisfaction was significantly greater (P< .0001). CONCLUSIONS: Home sleep monitoring is a valid and cost-effective diagnostic test; patients with symptoms of SAHS are more satisfied with this technique than conventional polysomnography.