Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea. Noninferiority, Randomized Controlled Trial.

RATIONALE: Home respiratory polygraphy may be a simpler alternative to in-laboratory polysomnography for the management of more symptomatic patients with obstructive sleep apnea, but its effectiveness has not been evaluated across a broad clinical spectrum. OBJECTIVES: To compare the long-term effectiveness (6 mo) of home respiratory polygraphy and polysomnography management protocols in patients with intermediate-to-high sleep apnea suspicion (most patients requiring a sleep study). METHODS: A multicentric, noninferiority, randomized controlled trial with two open parallel arms and a cost-effectiveness analysis was performed in 12 tertiary hospitals in Spain. Sequentially screened patients with sleep apnea suspicion were randomized to respiratory polygraphy or polysomnography protocols. Moreover, both arms received standardized therapeutic decision-making, continuous positive airway pressure (CPAP) treatment or a healthy habit assessment, auto-CPAP titration (for CPAP indication), health-related quality-of-life questionnaires, 24-hour blood pressure monitoring, and polysomnography at the end of follow-up. The main outcome was the Epworth Sleepiness Scale measurement. The noninferiority criterion was -2 points on the Epworth scale. MEASUREMENTS AND MAIN RESULTS: In total, 430 patients were randomized. The respiratory polygraphy protocol was noninferior to the polysomnography protocol based on the Epworth scale. Quality of life, blood pressure, and polysomnography were similar between protocols. Respiratory polygraphy was the most cost-effective protocol, with a lower per-patient cost of 416.7€. CONCLUSIONS: Home respiratory polygraphy management is similarly effective to polysomnography, with a substantially lower cost. Therefore, polysomnography is not necessary for most patients with suspected sleep apnea. This finding could change established clinical practice, with a clear economic benefit. Clinical trial registered with www.clinicaltrials.gov (NCT 01752556).

International Consensus Document on Obstructive Sleep Apnea. / Documento internacional de consenso sobre apnea obstructiva del sueño.

The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document. This document does not discuss pediatric patients or the management of patients receiving chronic non-invasive mechanical ventilation (these topics will be addressed in separate consensus documents).

[Sleep apnea-hypopnea syndrome and the heart]. / Síndrome de apneas-hipopneas durante el sueño y corazón.

Cardiovascular and cerebrovascular diseases are the most common diseases in industrialized societies. The main objectives of this article were to summarize the physiological effects of sleep apnea on the circulatory system and to review how treatment of this condition influences cardiovascular disease. Acute sleep apnea has a number of hemodynamic consequences, such as pulmonary and systemic hypertension, increased ventricular afterload and reduced cardiac output, all of which result from sympathetic stimulation, arousal, alterations in intrathoracic pressure, hypoxia and hypercapnia. When chronic, sleep apnea-hypopnea syndrome is associated with systemic hypertension, ischemic heart disease, congestive heart failure, and Cheyne-Stokes respiration in patients with congestive heart failure. Nocturnal treatment with continuous positive airway pressure decreases both the number of central apneic episodes and blood pressure in patients with sleep apnea-hypopnea syndrome and arterial hypertension.

[Effect on quality of life of nCPAP treatment in patients with obstructive sleep apnea]. / Efecto del tratamiento con presión positiva continua en la vía respiratoria durante la noche en la calidad de vida de los pacientes con apnea del sueño.

BACKGROUND AND OBJECTIVE: The standard treatment of the obstructive sleep apnea syndrome (OSAS) is the nCPAP. There is evidence that its use improves the quality of life of patients. The objective of the study is to measure the effect of nCPAP on the quality of life of patients in a Spanish cohort. PATIENTS AND METHOD: We have used 3 quality of life questionnaires: SF-36, EuroQol 5D and FOSQ. OSAS patients were interviewed at baseline prior to the start of the treatment and at 3 months follow-up. Two measures were employed to analyze the data: distribution based measures such as the effect size and instruments that evaluate the sensitivity to change of the questionnaires such as the ROC curves. RESULTS: We interviewed 124 patients. The benefit in terms of utility of the nCPAP was 0.03 with SF-36 and 0.04 with EuroQol 5D. Effect size varies from small (0.21) with EuroQol 5D to moderate (0.51) with FOSQ. SF-36 obtained intermediate scores (0.35). EuroQol 5D was the questionnaire that obtained the biggest area under the ROC curve. Nevertheless, the area size was small in all cases. CONCLUSIONS: nCPAP improves significantly the quality of life of OSAS patients. The assessment of the quality of life of OSAS patients with the available instruments is only partially satisfactory.