Comparison of respiratory polysomnographic parameters in matched cohorts of upper airway resistance and obstructive sleep apnea syndrome patients.

OBJECTIVE: To compare respiratory nocturnal polysomnography (NPSG) characteristics between matched cohorts of upper airway resistance syndrome (UARS) and obstructive sleep apnea syndrome (OSAS) patients. METHODS: All patients received 13-channel NPSG, including esophageal pressure (Pes) manometry. By definition, OSAS patients had an apnea-hypopnea index (AHI, number of apneas/hypopneas per hour total sleep time) > or = 15, and UARS patients had an AHI < 5. Respiratory effort-related arousal (RERA) was defined as the absence of apnea/hypopnea with > or = 10 s duration of progressive negative Pes, culminating in an arousal or microarousal. UARS patients, by definition, had > or = 15 RERAs per hour. Fifteen consecutively diagnosed UARS patients were matched with OSAS patients on the basis of body mass index (BMI) and gender. RESULTS: Respiratory disturbance index (sum of the AHI and RERA per hour) was the same for both cohorts: UARS, 36+/-4; OSAS, 42+/-6 (p = 0.34). There were no differences between cohorts for mean inspiratory Pes nadirs for each 30-s epoch of sleep compared for each sleep stage over an entire night. For randomly selected breaths from supine stage 2 sleep, the mean inspiratory Pes nadir was the same for the cohorts: UARS, -16.6+/-2 cm H2O; OSAS, -16.1+/-3 cm H2O (p = 0.30). Differences between cohorts for each parameter fell within respective 95% confidence intervals. CONCLUSION: With the exception of AHI, respiratory NPSG parameters were the same for UARS and OSAS patients when BMI and gender were controlled for.

Accuracy of respiratory inductive plethysmography for the diagnosis of upper airway resistance syndrome.

OBJECTIVE: To determine the sensitivity and specificity of quantitative respiratory inductive plethysmography (RIP) compared with the "gold standard," nocturnal esophageal pressure (Pes) measurement, in the diagnosis of upper airway resistance syndrome (UARS) in adults. METHODS: Fourteen consecutive patients without obstructive sleep apnea and suspected of having UARS underwent simultaneous measurement of Pes with a catheter and standard nocturnal polysomnography along with RIP. UARS events (RERAs, respiratory effort-related arousals) were identified by observing crescendo changes in Pes with a Pes nadir < or = -12 cm H2O, followed by an arousal or microarousal. UARS was defined as > or = 10 RERAs per hour. For each patient, the ratio of peak inspiratory flow to mean inspiratory flow (PIFMF) measured by RIP was performed during quiet wakefulness and with 40 randomly selected breaths in the supine position for two conditions: stage 2 sleep, immediately prior to arousals in any sleep stage. The mean PIFMF (wake-sleep) was calculated for each condition. RESULTS: The sensitivities and specificities, respectively, of RIP to distinguish UARS patients from non-UARS patients are from stage 2 sleep (67%, 80%), immediately prior to arousals (100%, 100%). For breaths occurring immediately prior to arousals, the mean PIFMF (wake-sleep) is > or = 0.13 for UARS patients and < 0.13 for non-UARS patients. CONCLUSION: The PIFMF measured by RIP allows for the most accurate identification of UARS patients when breaths are selected for analysis immediately prior to arousals.

Lack of predictive value of the Epworth Sleepiness Scale in patients after uvulopalatopharyngoplasty.

The Epworth Sleepiness Scale (ESS) has been recognized as a valid measure of sleep propensity. Statistically significant correlations between ESS scores, the respiratory disturbance index (RDI), and the lowest arterial oxygen saturation (LSAT) have been described in patients with surgically untreated obstructive sleep apnea (OSA). We investigated whether the same relationships hold true after uvulopalatopharyngoplasty (UPPP). Forty-two adults with documented OSA treated by UPPP were reevaluated with the ESS questionnaire and 8-hour diagnostic nocturnal polysomnography (nPSG). We found no significant correlation between the ESS scores and the RDI or LSAT in patients after UPPP. Because postoperative ESS scores do not correlate with the RDI or LSAT, we conclude that the ESS is not a reliable surrogate for nPSG testing.

Telemedicine in the sleep laboratory: feasibility and economic advantages of polysomnograms transferred online.

The costs for polysomnography (PSG) and alternative diagnostic procedures for sleep-disordered breathing are challenging public health care systems. We wanted to determine if a telemedicine protocol with online transfer of PSGs from a remote site could be cost-effective and clinically useful while improving patient access to full PSG. Fifty-nine PSGs were performed in 54 pulmonary patients with suspected sleep-disordered breathing at a remote hospital. The data were transferred by File Transfer Protocol (FTP) via the Internet to Walter Reed Army Medical Center (WRAMC) for scoring and interpretation. The results were faxed back to the remote hospital. Clinical utility was assessed by evaluating the reasons for patient referral and the resulting diagnoses. The economic benefits were calculated by comparing direct expenses of the telemedicine protocol with costs for contracting PSGs at outside sleep laboratories. A total of 93% (55) of all PSGs were transferred successfully online. Of the 54 patients, 47 had PSGs performed for diagnosis (including three split-night studies), 8 underwent treatment titration, and 1 patient had both overnight studies. Diagnoses were obstructive sleep apnea in 43 patients, central sleep apnea in 2, and upper airway resistance syndrome in 2. The disease conditions were defined as severe in 27 patients, moderate in 12 patients, and mild in 8 patients. Each PSG cost $700 (including costs for lost transmissions) compared to $1,250 for referral to a private sleep laboratory. A savings of $550 per study was realized with the telemedicine protocol. The online transfer of PSGs from a remote site to a centralized sleep laboratory is technically feasible and clinically useful. Telemedicine offers an effective alternative for cost reduction in sleep medicine while improving patient access to specialized care in remote areas.

Successful treatment of upper airway resistance syndrome with an oral appliance.

This case report is the first description of the treatment response to an oral appliance (OA) in a patient with upper airway resistance syndrome (UARS). OAs are devices inserted into the mouth in order to modify the position of the mandible and tongue, thus relieving pharyngeal obstruction during sleep in obstructive sleep apnea (OSA) patients. Findings from this case report suggest that an OA may be a useful treatment option for UARS patients.

Perfil sanitario de la poblacion concurrente a la seccion adolescencia de un hospital general. / Sanitary profile of a population cared in the adolescent section of a general hospital

Se analizan inicialmente las caracteristicas de los adolescentes y la atencion que reciben en la "Seccion Adolescencia" del Departamento de Medicina del Hospital Argerich, para considerarse luego analiticamente los 1.000 pacientes registrados entre 1979 y 1981. Se exponen los resultados antropometricos, edades de la poblacion y aparicion de caracteres sexuales.Con referencia a las patologias detectadas se las compara con los motivos de consulta, discriminandose en las areas organica y psicosocial. Finalmente, se postulan objetivos para la atencion de este grupo etario en nuestra populacion

Importacion del enfoque medico-clinico integral en adolescentes que solicitan orientacion vocacional. / Importance of the comprehensive medico-clinical approach in adolescents that request vocational guidance

Como parte de un control retrospectivo de historias clinicas pertenecientes a los ultimos 1.000 pacientes asistidos en la Seccion Adolescencia del Departamento de Medicina del Hospital General de Agudos Dr. Cosme Argerich se consideran 444 consultantes para Orientacion Vocacional. Se detallan las desviaciones organicas o psicosociales que surgen en algo mas del 50% de los mismos, consignandose segun edad y sexo. Se enfatiza asi la presencia indispensable del medico clinico en la atencion del adolescente y la confeccion de una historia clinica completa, aunque sus motivaciones iniciales de consulta sean del area aprendizaje (u otras), para concretar un enfoque multidisciplinario integral exitoso/