[Cost-effectiveness analysis of automatic titration of continuous positive airway pressure at home in 1 night versus 2 nights]. / Análisis de coste-eficacia de la graduación automática de la presión positiva continua de la vía aérea en el domicilio: eurouna o 2 noches?

OBJECTIVE: To assess the cost-effectiveness of automatic continuous positive airway pressure (CPAP) titration at home on 1 night or 2 consecutive nights in patients with the sleep apnea-hypopnea syndrome (SAHS). PATIENTS AND METHODS: A home titration study was performed using automatic CPAP for 2 consecutive nights on 100 patients with SAHS and an indication for CPAP. The number of successful studies and the costs of the first night and both nights were analyzed. The pressure requirements on each night and the agreement between the pressures selected visually by 2 different observers were compared. RESULTS: CPAP titration was successful in 85% and 80% of patients on the first night and second night, respectively, and in 88% of patients after both nights. No significant differences between the 2 nights were found for the following parameters: 95th percentile pressure (mean [SD], 10.2 [1.8] cm H(2)O and 10.2 [1.6] cm H(2)O on the first and second nights, respectively), mean pressure (7.8 [1.7] cm H(2)O and 7.7 [1.7] cm H(2)O), or the pressure selected visually (9.4 [1.5] cm H(2)O and 9.4 [1.4] cm H(2)O). Interobserver agreement on the pressure selected was good: the k statistics were 0.956 for the first night and 0.91 for the second night. The 1-night study cost euro232.63 and the 2-night study cost euro227.93. CONCLUSIONS: Automatic CPAP titration at home for 1 night enables a substantially greater number of patients to be studied at a similar cost than is possible when titration is accomplished in 2 consecutive nights.

[Effects of functional septoplasty in obstructive sleep apnea syndrome]. / Efectos de la septoplastia funcional en el síndrome de apnea obstructiva del sueño.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of functional septoplasty in a group of patients with septal dysmorphy and obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHOD: 34 patients with nasal respiratory insufficiency and chronic snore were included from 1997 to 2003. All of them were diagnosed of OSAS by nocturnal polysomnography (PSG) and of septal dysmorphy by ORL physical examination. Patients were clinically followed-up at 1, 3 and 6 months after surgery. PSG was also evaluated at 6 months postsurgery. RESULTS: A significant objective reduction of the apnea-hypopnea index (AHI) (45.8 vs 31.9), severity of OSAS, and minimal mean oxygen saturation (76.4 to 83.1) was found. Moreover, we observed a significant improvement of subjective scales of sleepiness (13 vs 6) and the patients' satisfaction degree (72% of patients improved). CONCLUSIONS: Functional septoplasty is an effective treatment in patients with OSAS and septal dysmorphy.

Predictive factors of quality-of-life improvement and continuous positive airway pressure use in patients with sleep apnea-hypopnea syndrome: study at 1 year.

STUDY OBJECTIVES: To assess predictive factors of quality-of-life (QoL) improvement and continuous positive airway pressure (CPAP) use in patients with sleep apnea-hypopnea syndrome (SAHS) after 1 year of treatment with CPAP. DESIGN: Observational, prospective cohort study. SETTING: Sleep unit in a university hospital. PATIENTS: One hundred thirty-three consecutive patients with an indication for CPAP treatment. MEASUREMENTS AND RESULTS: Nottingham health profile (NHP) questionnaire, Epworth sleepiness scale score, and objective CPAP use (time counter in the CPAP device) were assessed at baseline and after 3 months and 12 months of CPAP use. Multivariate logistic regression was used to identify predictive factors of CPAP use and improved QoL. At 1 year, 101 patients (76%) were still using CPAP; of these, 88 patients (66%) completed all the follow-up questionnaires. QoL was lower before treatment, compared with the general population, and all dimensions of the NHP, except social isolation, improved significantly from baseline in patients regularly using CPAP, reaching levels comparable to those of the general population at 1 year. Only minimum oxyhemoglobin saturation at diagnostic polysomnography was associated with the degree of QoL improvement at 1 year. Only the NHP and the apnea-hypopnea index (AHI) at baseline were significantly associated with hours of CPAP use at 1 year. CONCLUSIONS: Compared to the general population, patients with untreated SAHS had a lower QoL, which improved to the level of the general population after 3 months of CPAP therapy and persisted at 1 year of treatment with CPAP. The only predictor of QoL improvement was minimum nocturnal oxygen saturation at baseline. Higher AHI and worse QoL at baseline were predictors of hours of CPAP use.

Prevalence of insomnia and sleep characteristics in the general population of Spain.

OBJECTIVE: The goals of this study were to estimate the prevalence of insomnia symptomatology and diagnoses in the Spanish general population and to determine if certain sleep parameters were related to specific insomnia symptoms. METHODS: This is a cross-sectional telephone survey performed in the general population of Spain using a representative sample of 4065 individuals aged 15years or older. The participation rate was 87.5%. Interviews were conducted using the Sleep-EVAL system. The questions were related to sociodemographic characteristics, sleep-wake schedule, events occurring during sleep, insomnia symptoms, daytime consequences and DSM-IV diagnoses of sleep disorders. RESULTS: Overall, 20.8% (95% C.I. 19.6-22.1%) of the sample reported at least one insomnia symptom occurring at least three nights/week. The prevalence was higher in women than in men (23.9% vs. 17.6%) and increased with age. Difficulty maintaining sleep at least three nights/week was the most prevalent symptom. DSM-IV insomnia disorder diagnoses were found in 6.4% (95% C.I. 5.6-7.1%) of the sample. Delayed bedtime and wake-up time, irregular bedtime hours and hypnagogic hallucinations were the most frequent in participants who had difficulty initiating sleep. Perception of light and "too short" sleep were the most frequent in participants who had early morning awakenings. Participants who had a non-restorative sleep were more likely to extend sleep on days off than other insomnia participants. Medical consultations in the previous year were more frequent in insomnia participants compared to participants without insomnia. One-fifth of insomnia participants were using sleep-promoting medication. CONCLUSIONS: Insomnia is frequent in Spain, affecting up to one in five individuals. Results show that insomnia is multidimensional and needs to be assessed as such.

Obstructive sleep apnea and thoracic aorta dissection.

Obstructive sleep apnea syndrome (OSAS) is a process that is associated with the development of arterial hypertension, the main risk factor for aortic dissection and during obstructive episodes of the upper airways with marked increases in transmural pressure of the aorta wall. The aim of this work was to study the association between aortic dissection and OSAS. Nineteen consecutive patients with thoracic aorta dissection and 19 hypertensive patients of similar age, sex, and body mass index were studied by clinical questionnaire and polysomnography. Snoring and nonrefreshing sleep were common in both groups. Thirteen patients (68%) from each group showed an apnea-hypopnea index of more than 5 per hour. However, patients with aortic dissection presented a higher apnea-hypopnea index (28 [30.3] versus 11.1 [10.4], p=0.032). Seven patients with dissection presented an apnea-hypopnea index of more than 30 versus 1 patient in the control group (p=0.042). Patients with thoracic aorta dissection presented a high prevalence of previously undiagnosed and frequently severe OSAS. Further studies, including this diagnosis as a prognostic variable in the follow-up of patients with aortic dissection, are required. Our results suggest that in patients with aortic dissection and symptoms consistent with OSAS, a sleep study should be considered in their clinical management.