Defining the Profile of Obstructive Sleep Apnea in Women Compared to Men.

Background: The importance of understanding the presentation of obstructive sleep apnea (OSA) in women has been increasingly recognized. Although there is some insight that there are significant differences in presentation between women and men, the consequences of such differences, particularly for treatment have not yet been fully identified. Thus, the objective of this study was to determine the phenotype of OSA in women. Materials and Methods: Study of a population-based clinical cohort of 2022 patients with OSA confirmed by polygraphy or polysomnography (apnea-hypopnea index [AHI] >5/hour). Comorbidities, symptoms, physical examination, current medical treatments, and sleep parameters were recorded. Results: A total of 709 women and 1313 men were included in this study. After adjustment for anthropometric characteristics, morphological alterations, and previous treatment, women were found to have lower AHI values (25.3 ± 1.2 vs. 35.0 ± 0.9; p < 0.001), desaturation index (24.4 ± 1.2 vs. 33.2 ± 0.9; p < 0.001), and saturation time <90% (18.8 ± 1.3 vs. 24.1 ± 1.0; p < 0.001) compared with men. Furthermore, women had a lower risk of witnessed apnea (odds ratio adjusted [ORa] for baseline characteristics and sleep parameters), (ORa: 0.53, 95% confidence interval [CI]: 0.40-0.71), reduced sensation of restful sleep (ORa: 0.50, 95% CI: 0.38-0.66), greater fatigue (ORa: 2.68, 95% CI: 1.86-3.86), headache (ORa: 3.00, 95% CI: 2.26-3.97), memory disorders (ORa: 1.836, 95% CI: 1.40-2.41), insomnia (ORa: 2.09, 95% CI: 1.50-2.93), and excessive daytime sleepiness (ORa: 1.41, 95% CI: 1.03-1.92), with interference in their daily activities (ORa: 1.54, 95% CI: 1.17-2.03). Likewise, after adjustment for anthropometric characteristics and sleep parameters, women also showed higher risk of depression (ORa: 4.31, 95% CI: 3.15-5.89) and anxiety (ORa: 3.18, 95% CI: 2.38-4.26). Conclusions: Our findings suggest that women present a specific OSA phenotype, with a probable implication for clinical, diagnostic, and therapeutic management.

Defining the Heterogeneity of Sleep Apnea Syndrome: A Cluster Analysis With Implications for Patient Management.

INTRODUCTION: Obstructive sleep apnea (OSA) is a complex pathology with heterogeneity that has not been fully characterized to date. Our objective is to identify groups of patients with common clinical characteristics through cluster analysis that could predict patient prognosis, the impact of comorbidities and/or the response to a common treatment. METHODS: Cluster analysis was performed using the hierarchical cluster method in 2025 patients in the apnea-HUGU cohort. The variables used for building the clusters included general data, comorbidity, sleep symptoms, anthropometric data, physical exam and sleep study results. RESULTS: Four clusters were identified: (1) young male without comorbidity with moderate apnea and otorhinolaryngological malformations; (2) middle-aged male with very severe OSA with comorbidity without cardiovascular disease; (3) female with mood disorder; and (4) symptomatic male with established cardiovascular disease and severe OSA. CONCLUSIONS: The characterization of these four clusters in OSA can be decisive when identifying groups of patients who share a special risk or common therapeutic strategies, orienting us toward personalized medicine and facilitating the design of future clinical trials.

Clinical utility and economic impact of conventional transbronchial needle aspiration of mediastinal lymphadenopathies in bronchogenic carcinoma.

OBJECTIVES: To analyze the clinical utility and economic impact of conventional transbronchial needle aspiration (TBNA) in patients with diagnosis of bronchogenic carcinoma (BC) and mediastinal lymphadenopathies in thoracic computed tomography (CT). To assess the predictive factors of valid aspirations. PATIENTS AND METHODS: Retrospective observational study between 2006 and 2011 of all TBNA performed in patients with final diagnosis of BC and accessible hilar or mediastinal lymphadenopathies on thoracic CT. RESULTS: We performed TBNA on 267 lymphadenopathies of 192 patients. In 34.9% of patients, two or more lymph nodes were biopsied. Valid aspirations were obtained in 153 patients (79.7%) that were diagnostic in 124 (64.6%). Multivariate analysis showed that factors associated with valid or diagnostic results are the diameter of the lymph node and the number of lymph nodes explored. TBNA was the only endoscopic technique that provided the diagnosis of BC in 54 patients (28.1%). Staging mediastinoscopy was avoided in 67.6% of patients. The prevalence of mediastinal lymph node involvement was 74.4%, sensitivity of TBNA was 86.2% and negative predictive value was 63.6%. Including mediastinoscopy and other avoided diagnostic techniques, TBNA saved 451.57 € per patient. CONCLUSIONS: TBNA is a clinically useful, cost-effective technique in patients with BC and mediastinal or hilar lymphadenopathies. It should therefore be performed on a regular basis during diagnostic bronchoscopy of these patients.