RESUMEN
BACKGROUND: OSA has been associated with increased incidence and aggressiveness of melanoma. However, the long-term impact of OSA and CPAP treatment on the prognosis of melanoma remains unexplored. RESEARCH QUESTION: Are OSA and CPAP treatment associated independently with a poor prognosis for cutaneous melanoma? STUDY DESIGN AND METHODS: Four hundred forty-three patients with a diagnosis of cutaneous melanoma (2012-2015) underwent a sleep study within 6 months of diagnosis. The main 5-year outcome of the study was a composite of melanoma recurrence, metastasis, or mortality. Patients were divided into four groups: baseline apnea-hypopnea index (AHI) of fewer than 10 events/h (no OSA; control group), OSA treated with CPAP and good adherence, untreated or poor CPAP adherence in moderate (AHI, 10-29 events/h), and severe OSA (AHI, ≥ 30 events/h). Survival analysis was used to determine the independent role of OSA and CPAP treatment on melanoma composite outcome. RESULTS: Three hundred ninety-one patients (88.2%) were available for analysis at 5-year follow-up (mean age, 65.1 ± 15.2 years; 49% male; Breslow index, 1.7 ± 2.5 mm). One hundred thirty-nine patients had AHI of fewer than 10 events/h (control group); 78 patients with OSA were adherent to CPAP; and 124 and 50 patients had moderate and severe OSA, respectively, without CPAP treatment. Median follow-up was 60 months (interquartile range, 51-74 months). During follow-up, 32 relapses, 53 metastases, and 52 deaths occurred (116 patients showed at least one of the main composite outcomes). After adjusting for age, sex, sentinel lymph nodes affected at diagnosis, BMI, diabetes, nighttime with an oxygen saturation below 90%, Breslow index, Epworth sleepiness scale scores, and melanoma treatment, moderate (hazard ratio [HR], 2.45; 95% CI, 1.09-5.49) and severe OSA (HR, 2.96; 95% CI, 1.36-6.42) were associated with poorer prognosis of melanoma compared with the control group. However, good adherence to CPAP avoided this excess risk (HR, 1.66; 95% CI, 0.71-3.90). INTERPRETATION: Moderate to severe untreated OSA is an independent risk factor for poor prognosis of melanoma. Treatment with CPAP is associated with improved melanoma outcomes compared with untreated moderate to severe OSA.
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Melanoma , Neoplasias Cutáneas , Síndromes de la Apnea del Sueño , Apnea Obstructiva del Sueño , Humanos , Masculino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Femenino , Apnea Obstructiva del Sueño/complicaciones , Melanoma/terapia , Melanoma/complicaciones , Estudios Prospectivos , Neoplasias Cutáneas/complicaciones , Recurrencia Local de Neoplasia/epidemiología , Síndromes de la Apnea del Sueño/complicaciones , Pronóstico , Presión de las Vías Aéreas Positiva ContínuaRESUMEN
Rationale: Obstructive sleep apnea (OSA) is associated with impaired glycemic control and a higher risk of vascular complications, such as diabetic kidney disease (DKD). However, the effect of apnea-hypopnea suppression on DKD progression is unclear. Objectives: To assess the effect of continuous positive airway pressure (CPAP) on the urinary albumin-to-creatinine ratio (UACR) in patients with DKD and OSA. Methods: In a 52-week, multicentric, open-label, parallel, and randomized clinical trial, 185 patients with OSA and DKD were randomized to CPAP and usual care (n = 93) or usual care alone (n = 92). Measurements and Main Results: UACR, estimated glomerular filtration rate, serum concentrations of creatinine and glycated hemoglobin, insulin resistance, lipid concentrations, sleepiness, and quality of life. A 52-week change in UACR from baseline did not differ significantly between the CPAP group and the usual-care group. However, in per-protocol analyses that included 125 participants who met prespecified criteria for adherence, CPAP treatment was associated with a great reduction in UACR (mean difference, -10.56% [95% confidence interval, -19.06 to -2.06]; P = 0.015). CPAP effect on UACR was higher in nonsleepy patients with more severe OSA, worse renal function, and a more recent diagnosis of DKD. CPAP treatment also improved glycemic control and insulin resistance, as well as sleepiness and health-related quality of life. Conclusions: In patients with OSA and DKD, the prescription of CPAP did not result in a statistically significant reduction in albuminuria. However, good adherence to CPAP treatment in addition to usual care may result in long-term albuminuria reduction compared with usual care alone. Clinical trial registered with www.clinicaltrials.gov (NCT02816762).
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Albuminuria , Nefropatías Diabéticas , Resistencia a la Insulina , Apnea Obstructiva del Sueño , Humanos , Albuminuria/etiología , Presión de las Vías Aéreas Positiva Contínua/métodos , Creatinina , Diabetes Mellitus , Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/terapia , Calidad de Vida , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/terapia , SomnolenciaRESUMEN
El objetivo principal de este documento internacional de consenso sobre apnea obstructiva del sueño es proporcionar unas directrices que permitan a los profesionales sanitarios tomar las mejores decisiones en la asistencia de los pacientes adultos con esta enfermedad según un resumen crítico de la literatura más actualizada. El grupo de trabajo de expertos se ha constituido principalmente por 17 sociedades científicas y 56 especialistas con amplia representación geográfica (con la participación de 4 sociedades internacionales), además de un metodólogo experto y un documentalista del Centro Cochrane Iberoamericano. El documento consta de un manuscrito principal, con las novedades más relevantes, y una serie de manuscritos online que recogen las búsquedas bibliográficas sistemáticas de cada uno de los apartados del documento internacional de consenso. Este documento no cubre la edad pediátrica ni el manejo del paciente en ventilación mecánica crónica no invasiva (que se publicarán en sendos documentos de consenso aparte). Palabras clave: Apnea obstructiva del sueño Diagnóstico Tratamiento
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). Keywords: Obstructive sleep apnea Diagnosis Treatment
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Humanos , Ciencias de la Salud , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/patología , Apnea Obstructiva del Sueño/prevención & control , Apnea Obstructiva del Sueño/rehabilitación , Apnea Obstructiva del Sueño/terapiaRESUMEN
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).
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Obstructive sleep apnea (OSA) is a recognized risk factor for the development of diabetic kidney disease (DKD). Our objectives were to compare the urinary albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) of patients with DKD according to OSA severity, and to evaluate the contribution of sleep parameters to their renal function. In a multicenter, observational, cross-sectional study, 214 patients with DKD were recruited. After a sleep study, UACR and eGFR were measured, as well as serum creatinine, fasting glucose, glycated hemoglobin, insulin resistance, lipid profile and C-reactive protein. UACR was higher in severe OSA patients (920 ± 1053 mg/g) than in moderate (195 ± 232 mg/g, p < 0.001) or mild OSA/non-OSA subjects (119 ± 186 mg/g, p < 0.001). At the same time, eGFR showed an OSA severity-dependent reduction (48 ± 23 vs. 59 ± 21 vs. 73 ± 19 ml/min per 1.73 m2, respectively; p < 0.001). Apnea-hypopnea index (AHI and desaturation index (ODI) were identified as independent predictors for UACR and eGFR, respectively. Therefore, in patients with DKD under optimized treatment, severe OSA is associated with a higher UACR and a lower eGFR, reflecting an additional contribution to the impairment of their renal function, although no causality can be inferred.
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Nefropatías Diabéticas/complicaciones , Nefropatías Diabéticas/fisiopatología , Pruebas de Función Renal , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/fisiopatología , Anciano , Albuminuria/complicaciones , Albuminuria/fisiopatología , Creatinina/orina , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Riñón/patología , Riñón/fisiopatología , Modelos Lineales , Masculino , Análisis Multivariante , Sueño/fisiologíaRESUMEN
No disponible
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Humanos , Suicidio/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Depresión/epidemiología , Intento de Suicidio/estadística & datos numéricos , Infecciones por Coronavirus/psicología , Pandemias/estadística & datos numéricos , Factores de Riesgo , Suicidio/prevención & control , Intento de Suicidio/prevención & controlRESUMEN
BACKGROUND: Noninvasive ventilation (NIV) is an effective form of treatment in obesity hypoventilation syndrome (OHS) with severe OSA. However, there is paucity of evidence in patients with OHS without severe OSA phenotype. RESEARCH QUESTION: Is NIV effective in OHS without severe OSA phenotype? STUDY DESIGN AND METHODS: In this multicenter, open-label parallel group clinical trial performed at 16 sites in Spain, we randomly assigned 98 stable ambulatory patients with untreated OHS and apnea-hypopnea index < 30 events/h (ie, no severe OSA) to NIV or lifestyle modification (control group) using simple randomization through an electronic database. The primary end point was hospitalization days per year. Secondary end points included other hospital resource utilization, incident cardiovascular events, mortality, respiratory functional tests, BP, quality of life, sleepiness, and other clinical symptoms. Both investigators and patients were aware of the treatment allocation; however, treating physicians from the routine care team were not aware of patients' enrollment in the clinical trial. The study was stopped early in its eighth year because of difficulty identifying patients with OHS without severe OSA. The analysis was performed according to intention-to-treat and per-protocol principles and by adherence subgroups. RESULTS: Forty-nine patients in the NIV group and 49 in the control group were randomized, and 48 patients in each group were analyzed. During a median follow-up of 4.98 years (interquartile range, 2.98-6.62), the mean hospitalization days per year ± SD was 2.60 ± 5.31 in the control group and 2.71 ± 4.52 in the NIV group (adjusted rate ratio, 1.07; 95% CI, 0.44-2.59; P = .882). NIV therapy, in contrast with the control group, produced significant longitudinal improvement in Paco2, pH, bicarbonate, quality of life (Medical Outcome Survey Short Form 36 physical component), and daytime sleepiness. Moreover, per-protocol analysis showed a statistically significant difference for the time until the first ED visit favoring NIV. In the subgroup with high NIV adherence, the time until the first event of hospital admission, ED visit, and mortality was longer than in the low adherence subgroup. Adverse events were similar between arms. INTERPRETATION: In stable ambulatory patients with OHS without severe OSA, NIV and lifestyle modification had similar long-term hospitalization days per year. A more intensive program aimed at improving NIV adherence may lead to better outcomes. Larger studies are necessary to better determine the long-term benefit of NIV in this subgroup of OHS. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01405976; URL: www.clinicaltrials.gov.
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Ventilación no Invasiva/métodos , Síndrome de Hipoventilación por Obesidad/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , FenotipoRESUMEN
BACKGROUND: Obesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities. OBJECTIVES: We performed a large, multicentre, randomised, open-label controlled study to determine the comparative long-term cost and effectiveness of NIV versus CPAP in patients with OHS with severe obstructive sleep apnoea (OSA) using hospitalisation days as the primary outcome measure. METHODS: Hospital resource utilisation and within trial costs were evaluated against the difference in effectiveness based on the primary outcome (hospitalisation days/year, transformed and non-transformed in monetary term). Costs and effectiveness were estimated from a log-normal distribution using a Bayesian approach. A secondary analysis by adherence subgroups was performed. RESULTS: In total, 363 patients were selected, 215 were randomised and 202 were available for the analysis. The median (IQR) follow-up was 3.01 (2.91-3.14) years for NIV group and 3.00 (2.92-3.17) years for CPAP. The mean (SD) Bayesian estimated hospital days was 2.13 (0.73) for CPAP and 1.89 (0.78) for NIV. The mean (SD) Bayesian estimated cost per patient/year in the NIV arm, excluding hospitalisation costs, was 2075.98 (91.6), which was higher than the cost in the CPAP arm of 1219.06 (52.3); mean difference 857.6 (105.5). CPAP was more cost-effective than NIV (99.5% probability) because longer hospital stay in the CPAP arm was compensated for by its lower costs. Similar findings were observed in the high and low adherence subgroups. CONCLUSION: CPAP is more cost-effective than NIV; therefore, CPAP should be the preferred treatment for patients with OHS with severe OSA. TRIAL REGISTRATION NUMBER: NCT01405976.
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Presión de las Vías Aéreas Positiva Contínua/economía , Análisis Costo-Beneficio , Síndrome de Hipoventilación por Obesidad/terapia , Anciano , Teorema de Bayes , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Ventilación no Invasiva , Síndrome de Hipoventilación por Obesidad/fisiopatología , Polisomnografía , Índice de Severidad de la Enfermedad , España , EspirometríaRESUMEN
BACKGROUND: Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients' lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create. METHODS: A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies. RESULTS: The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million and social return to 272 million , so each euro invested could yield almost 2 of social return. CONCLUSIONS: This study could guide health interventions, resulting in money savings for the SNHS and increases in patients' quality of life.
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Esclerosis Múltiple/terapia , Programas Nacionales de Salud/economía , Valores Sociales , Análisis Costo-Beneficio , Humanos , Inversiones en Salud , Esclerosis Múltiple/economía , EspañaRESUMEN
Rationale: Obesity hypoventilation syndrome (OHS) has been associated with cardiac dysfunction. However, randomized trials assessing the impact of long-term noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) on cardiac structure and function assessed by echocardiography are lacking.Objectives: In a prespecified secondary analysis of the largest multicenter randomized controlled trial of OHS (Pickwick Project; N = 221 patients with OHS and coexistent severe obstructive sleep apnea), we compared the effectiveness of three years of NIV and CPAP on structural and functional echocardiographic changes.Methods: At baseline and annually during three sequential years, patients underwent transthoracic two-dimensional and Doppler echocardiography. Echocardiographers at each site were blinded to the treatment allocation. Statistical analysis was performed using a linear mixed-effects model with a treatment group and repeated measures interaction to determine the differential effect between CPAP and NIV.Measurements and Main Results: A total of 196 patients were analyzed: 102 were treated with CPAP and 94 were treated with NIV. Systolic pulmonary artery pressure decreased from 40.5 ± 1.47 mm Hg at baseline to 35.3 ± 1.33 mm Hg at three years with CPAP, and from 41.5 ± 1.56 mm Hg to 35.5 ± 1.42 with NIV (P < 0.0001 for longitudinal intragroup changes for both treatment arms). However, there were no significant differences between groups. NIV and CPAP therapies similarly improved left ventricular diastolic dysfunction and reduced left atrial diameter. Both NIV and CPAP improved respiratory function and dyspnea.Conclusions: In patients with OHS who have concomitant severe obstructive sleep apnea, long-term treatment with NIV and CPAP led to similar degrees of improvement in pulmonary hypertension and left ventricular diastolic dysfunction.Clinical trial registered with www.clinicaltrials.gov (NCT01405976).
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Presión de las Vías Aéreas Positiva Contínua/métodos , Hipertensión Pulmonar/diagnóstico por imagen , Síndrome de Hipoventilación por Obesidad/terapia , Apnea Obstructiva del Sueño/terapia , Disfunción Ventricular Izquierda/diagnóstico por imagen , Anciano , Presión Sanguínea , Diástole , Ecocardiografía , Ecocardiografía Doppler , Femenino , Humanos , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Ventilación no Invasiva/métodos , Síndrome de Hipoventilación por Obesidad/diagnóstico por imagen , Síndrome de Hipoventilación por Obesidad/fisiopatología , Arteria Pulmonar , Apnea Obstructiva del Sueño/diagnóstico por imagen , Apnea Obstructiva del Sueño/fisiopatología , Resultado del Tratamiento , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: Although the pathogenesis of central and obstructive events seems to be different, these two entities may somehow be related. We aimed to determine whether, as reported in previous research, the number of central sleep apnea (CSA) cases in a population of children with obstructive sleep apnea syndrome (OSAS) was greater than in patients without obstructive events, and if CSA worsens with increasing OSAS severity. As a second objective, we analyzed changes in central apnea index (CAI) after adenotonsillar surgery compared to changes when no surgery has been performed. METHODS: We retrospectively reviewed nocturnal polysomnography (PSG) data from children between 1 and 14 years of age with no neurological conditions or syndromes. Patients with CAI values greater than 5 per hour were diagnosed as having CSA. Improvements of greater than 50% in CAI on repeat PSG were considered to represent a real change. RESULTS: Data were available from 1279 PSG studies, resulting in 72 children with a CAI greater than 5 per hour (5.6%). Patients with OSAS showed a higher CAI (2.16) compared with those without OSAS (1.17), and this correlation increased with higher degrees of obstructive apnea severity. When adenotonsillectomy was performed due to OSAS, the CAI decreased by 1.37. The average decrease in PSG values was only 0.38 in cases where no surgery was performed. CONCLUSION: The results of this study suggest that although CSA is perceived to be mostly associated with central nervous system ventilatory control, there may be a connection with airway obstruction and in children with CSA and OSA diagnosis adenotonsillectomy may improve both conditions.
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Adenoidectomía , Apnea Central del Sueño/cirugía , Tonsilectomía , Adolescente , Obstrucción de las Vías Aéreas/cirugía , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Polisomnografía , Estudios Retrospectivos , Apnea Central del Sueño/complicaciones , Apnea Central del Sueño/diagnóstico , Apnea Obstructiva del Sueño/complicacionesRESUMEN
OBJETIVO: Describir la percepción de las enfermeras sobre la calidad de los cuidados que prestan y de su entorno laboral, así como analizar las características del sueño. Analizar si existe relación entre la unidad y el turno de trabajo con la percepción de las enfermeras de su entorno laboral y con la calidad de sueño y la somnolencia diurna. MÉTODO: Estudio multicéntrico, observacional, descriptivo realizado entre los años 2012 y 2014 en 7 hospitales españoles del Sistema Nacional de Salud que mostraron su interés por participar en este proyecto de seguimiento. Se ha medido el entorno laboral, la satisfacción laboral, la calidad del sueño y la calidad de los cuidados con herramientas validadas. RESULTADOS: Participaron en el estudio 635 enfermeras. Un 83,7% percibía la calidad de los cuidados como buena/excelente, y el 55,1% valoró el entorno laboral de su hospital como bueno/excelente. El PES-NWI clasificó al 39% de los hospitales como desfavorable y al 20% como favorable. El 15,4% de las enfermeras tenía alto nivel de burnout y el 58,3% bajo. La calidad del sueño fue de 6,38 para el turno de día, de 6,78 para el turno rotatorio y de 7,93 para el turno de noche. Se encontraron diferencias en la calidad subjetiva, en la duración, en las perturbaciones del sueño y en la disfunción durante el día. CONCLUSIONES: En la prestación de cuidados de calidad interactúan multitud de factores como el turno, la unidad, la satisfacción, la percepción de la seguridad y la calidad del sueño
OBJECTIVE: To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. METHODS: A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. RESULTS: 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. CONCLUSIONS: In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality
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Humanos , Masculino , Femenino , Adulto , Calidad de la Atención de Salud , Ambiente de Instituciones de Salud , Sistemas Nacionales de Salud/organización & administración , Atención de Enfermería/psicología , Somnolencia , Agotamiento Profesional/enfermería , Evaluación del Rendimiento de Empleados , Enfermeras y Enfermeros/estadística & datos numéricos , Satisfacción en el TrabajoRESUMEN
BACKGROUND: Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma. METHODS: Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spreading of the melanoma) was performed. RESULTS: Patients in the upper tertiles of AHI or DI4% were 1.94 (95% CI, 1.14-3.32; P = .022) and 1.93 (95% CI, 1.14-3.26; P = .013) times more likely, respectively, to present with aggressive melanoma (Breslow index > 1 mm) than those in the lowest tertiles of these sleep attributes after adjustment for age, sex, tumor location, and BMI. This association was particularly prominent among patients < 56 years of age with Breslow index > 2 mm. The presence of the additional markers of aggressiveness was also associated with higher AHI and DI4% values. CONCLUSIONS: The severity of SDB was independently associated with greater aggressiveness of cutaneous melanoma, particularly among younger patients.
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Melanoma , Oxihemoglobinas/análisis , Polisomnografía/métodos , Neoplasias Cutáneas , Síndromes de la Apnea del Sueño , Factores de Edad , Biomarcadores de Tumor/análisis , Índice de Masa Corporal , Estudios Transversales , Femenino , Humanos , Masculino , Melanoma/complicaciones , Melanoma/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Factores de Riesgo , Índice de Severidad de la Enfermedad , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patología , Síndromes de la Apnea del Sueño/sangre , Síndromes de la Apnea del Sueño/complicaciones , Síndromes de la Apnea del Sueño/diagnóstico , Melanoma Cutáneo MalignoRESUMEN
OBJECTIVE: To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. METHODS: A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. RESULTS: 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. CONCLUSIONS: In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality.
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RATIONALE: Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysfunction, no randomised trials have assessed the impact of non-invasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography. OBJECTIVES: We performed a secondary analysis of the data from the largest multicentre randomised controlled trial of OHS (Pickwick project, n=221) to determine the comparative efficacy of 2 months of NIV (n=71), CPAP (n=80) and lifestyle modification (control group, n=70) on structural and functional echocardiographic changes. METHODS: Conventional transthoracic two-dimensional and Doppler echocardiograms were obtained at baseline and after 2 months. Echocardiographers at each site were blinded to the treatment arms. Statistical analysis was performed using intention-to-treat analysis. RESULTS: At baseline, 55% of patients had pulmonary hypertension and 51% had evidence of left ventricular hypertrophy. Treatment with NIV, but not CPAP, lowered systolic pulmonary artery pressure (-3.4 mm Hg, 95% CI -5.3 to -1.5; adjusted P=0.025 vs control and P=0.033 vs CPAP). The degree of improvement in systolic pulmonary artery pressure was greater in patients treated with NIV who had pulmonary hypertension at baseline (-6.4 mm Hg, 95% CI -9 to -3.8). Only NIV therapy decreased left ventricular hypertrophy with a significant reduction in left ventricular mass index (-5.7 g/m2; 95% CI -11.0 to -4.4). After adjusted analysis, NIV was superior to control group in improving left ventricular mass index (P=0.015). Only treatment with NIV led to a significant improvement in 6 min walk distance (32 m; 95% CI 19 to 46). CONCLUSION: In patients with OHS, medium-term treatment with NIV is more effective than CPAP and lifestyle modification in improving pulmonary hypertension, left ventricular hypertrophy and functional outcomes. Long-term studies are needed to confirm these results. TRIAL REGISTRATION NUMBER: Pre-results, NCT01405976 (https://clinicaltrials.gov/).
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua , Ecocardiografía Doppler , Ventilación no Invasiva , Síndrome de Hipoventilación por Obesidad/diagnóstico , Síndrome de Hipoventilación por Obesidad/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Presión de las Vías Aéreas Positiva Contínua/métodos , Ecocardiografía Doppler/métodos , Femenino , Estudios de Seguimiento , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Ventilación no Invasiva/métodos , Síndrome de Hipoventilación por Obesidad/fisiopatología , Polisomnografía/métodos , Calidad de Vida , España , Espirometría , Resultado del TratamientoRESUMEN
OBJECTIVE: Snoring is a common reason for referral to a sleep unit. Although there are several instruments to measure snoring, there is no gold standard for this purpose. In this study, we determine the diagnostic accuracy of the cannula as compared with the microphone, which are the two most commonly used tools. STUDY DESIGN: We performed a cross-sectional study of 75 patients who underwent baseline home sleep apnea testing for any reason. METHODS: Snore intensity and percentage were assessed during Home sleep-apnea testing via nasal cannula and microphone in all patients. We performed a complete diagnostic accuracy analysis, assuming the microphone to be the reference instrument use in order to compare it with the cannula. RESULTS: The intra-class correlation coefficient between the cannula and microphone for the percentage of snoring was 0.25. The Bland Bland-Altman analysis to determine the agreement regarding the percentage of snoring showed a lower limit of -57.73 and an upper limit of 20.30. A linear regression analysis of the differences produced a negative slope of -0.86. The receiver operating characteristic curve for severe snoring using the cannula produced an area under the curve of 0.67 (P = 0.019). The cannula showed a sensitivity of 57.89 and a specificity of 73.21. CONCLUSION: The nasal cannula showed poor reliability and accuracy for measuring snoring. LEVEL OF EVIDENCE: 2b. Laryngoscope, 127:2886-2890, 2017.
Asunto(s)
Síndromes de la Apnea del Sueño/diagnóstico , Ronquido/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Cánula , Estudios Transversales , Técnicas de Diagnóstico del Sistema Respiratorio/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Síndromes de la Apnea del Sueño/complicaciones , Ronquido/etiologíaRESUMEN
STUDY OBJECTIVES: Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). However, there is a paucity of data regarding its efficacy and safety. The objective of this study was to assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS. METHODS: In this post hoc analysis of a previous randomized controlled trial, we studied 302 sequentially screened OHS patients who were randomly assigned to noninvasive ventilation, continuous positive airway pressure, or lifestyle modification. Outcomes at 2 mo included arterial blood gases, symptoms, quality of life, blood pressure, polysomnography, spirometry, 6-min walk distance, and hospital resource utilization. Statistical analysis comparing patients with and without oxygen therapy in the three treatment groups was performed using an intention-to-treat analysis. RESULTS: In the noninvasive ventilation group, supplemental oxygen reduced systolic blood pressure although this could be also explained by a reduction in body weight experienced in this group. In the continuous positive airway pressure group, supplemental oxygen increased the frequency of morning confusion. In the lifestyle modification group, supplemental oxygen increased compensatory metabolic alkalosis and decreased the apnea-hypopnea index during sleep. Oxygen therapy was not associated with an increase in hospital resource utilization in any of the groups. CONCLUSIONS: After 2 mo of follow-up, chronic oxygen therapy produced marginal changes that were insufficient to consider it, globally, as beneficial or deleterious. Because supplemental oxygen therapy did not increase hospital resource utilization, we recommend prescribing oxygen therapy to patients with OHS who meet criteria with close monitoring. Long-term studies examining outcomes such as incident cardiovascular morbidity and mortality are necessary. CLINICAL TRIALS REGISTRATION: Clinicaltrial.gov, ID: NCT01405976.
Asunto(s)
Síndrome de Hipoventilación por Obesidad/terapia , Terapia por Inhalación de Oxígeno/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de los Gases de la Sangre/estadística & datos numéricos , Presión Sanguínea , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía/estadística & datos numéricos , Calidad de Vida , España , Espirometría/estadística & datos numéricos , Resultado del Tratamiento , Caminata/estadística & datos numéricos , Adulto JovenRESUMEN
OBJECTIVE: The main objective of this study was to determine the relationship between the characteristics of nurses' work environments in hospitals in the Spanish National Health System (SNHS) with nurse reported quality of care, and how care was provided by using different shifts schemes. The study also examined the relationship between job satisfaction, burnout, sleep quality and daytime drowsiness of nurses and shift work. METHODS: This was a multicentre, observational, descriptive, cross-sectional study, centred on a self-administered questionnaire. The study was conducted in seven SNHS hospitals of different sizes. We recruited 635 registered nurses who worked on day, night and rotational shifts on surgical, medical and critical care units. Their average age was 41.1â years, their average work experience was 16.4â years and 90% worked full time. A descriptive and bivariate analysis was carried out to study the relationship between work environment, quality and safety care, and sleep quality of nurses working different shift patterns. RESULTS: 65.4% (410) of nurses worked on a rotating shift. The Practice Environment Scale of the Nursing Work Index classification ranked 20% (95) as favourable, showing differences in nurse manager ability, leadership and support between shifts (p=0.003). 46.6% (286) were sure that patients could manage their self-care after discharge, but there were differences between shifts (p=0.035). 33.1% (201) agreed with information being lost in the shift change, showing differences between shifts (p=0.002). The Pittsburgh Sleep Quality Index reflected an average of 6.8 (SD 3.39), with differences between shifts (p=0.017). CONCLUSIONS: Nursing requires shift work, and the results showed that the rotating shift was the most common. Rotating shift nurses reported worse perception in organisational and work environmental factors. Rotating and night shift nurses were less confident about patients' competence of self-care after discharge. The most common nursing care omissions reported were related to nursing care plans. For the Global Sleep Quality score, difference were found between day and night shift workers.
Asunto(s)
Enfermeras y Enfermeros/psicología , Calidad de la Atención de Salud/normas , Horario de Trabajo por Turnos , Trastornos del Sueño del Ritmo Circadiano/epidemiología , Sueño/fisiología , Lugar de Trabajo/normas , Adulto , Agotamiento Profesional/epidemiología , Estudios Transversales , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Psicometría , Autocuidado , España , Encuestas y Cuestionarios , Tolerancia al Trabajo ProgramadoRESUMEN
BACKGROUND: Non-invasive ventilation (NIV) is an effective form of treatment in patients with obesity hypoventilation syndrome (OHS) who have concomitant severe obstructive sleep apnoea (OSA). However, there is a paucity of evidence on the efficacy of NIV in patients with OHS without severe OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification (control group) using daytime arterial carbon dioxide tension (PaCO2) as the main outcome measure. METHODS: Between May 2009 and December 2014 we sequentially screened patients with OHS without severe OSA. Participants were randomised to NIV versus lifestyle modification and were followed for 2â months. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated. Statistical analysis was performed using intention-to-treat analysis. RESULTS: A total of 365 patients were screened of whom 58 were excluded. Severe OSA was present in 221 and the remaining 86 patients without severe OSA were randomised. NIV led to a significantly larger improvement in PaCO2 of -6 (95% CI -7.7 to -4.2)â mmâ Hg versus -2.8 (95% CI -4.3 to -1.3)â mmâ Hg, (p<0.001) and serum bicarbonate of -3.4 (95% CI -4.5 to -2.3) versus -1 (95% CI -1.7 to -0.2 95% CI) â mmol/L (p<0.001). PaCO2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related quality of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification. Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. CONCLUSIONS: NIV is more effective than lifestyle modification in improving daytime PaCO2, sleepiness and polysomnographic parameters. Long-term prospective studies are necessary to determine whether NIV reduces healthcare resource utilisation, cardiovascular events and mortality. TRIAL REGISTRATION NUMBER: NCT01405976; results.