RESUMEN
Obstructive sleep apnea (OSA) encompasses a diverse population, manifesting with or without symptoms of excessive daytime sleepiness. There is contention surrounding the significance of non-sleepy OSA within clinical contexts and whether routine treatment is warranted. This study aims to evaluate epidemiological and clinical distinctions between sleepy and non-sleepy OSA patients. A retrospective analysis was conducted on consecutive patients undergoing polysomnography for OSA assessment at tertiary care hospitals between 2018 and 2023. For 176 of 250 patients, complete polysomnography records with OSA diagnoses were available. Non-sleepy OSA was defined when a patient had an Epworth sleepiness scale score <10 and polysomnography demonstrated an apnea hypopnea index ≥5/hour. Non-sleepy OSA patients were matched with sleepy OSA patients in terms of age and gender distribution (mean age 51.24±13.25 years versus 50.9±10.87 years, male 70.4% versus 73.3%). The sensitivity of STOP-BANG≥3 for the non-sleepy OSA group was 87.7%, 89.3%, and 95.2% for any OSA severity, moderate to severe OSA, and severe OSA, respectively, while the corresponding sensitivity for the sleepy OSA group was 96.5%, 98.6%, and 100% for any OSA severity, moderate to severe OSA, and severe OSA, respectively. A novel symptom scoring tool, HASSUN (hypertension, nocturnal apneas, snoring, sleep disturbance, unrefreshing sleep, and nocturia), demonstrated a sensitivity of over 90% for all severity categories of OSA in both non-sleepy and sleepy OSA groups. The prevalence of cardiovascular and metabolic comorbidities did not significantly differ between non-sleepy and sleepy OSA patients. The physiological parameters, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, arterial partial pressure of oxygen, and bicarbonate at baseline, were comparable between the two groups. To conclude, non-sleepy OSA patients are less obese, exhibit fewer symptoms, and have less severe OSA in comparison to sleepy OSA. Non-sleepy OSA patients display a similar likelihood of cardiovascular and metabolic comorbidities compared to sleepy OSA patients. Further investigations are warranted to elucidate the mechanisms underlying cardiovascular metabolic comorbidities in non-sleepy OSA patients. The proposed HASSUN scoring tool for non-sleepy OSA screening necessitates validation in future studies.
RESUMEN
Introduction: Coronavirus disease 2019 (COVID-19) pneumonia is a heterogeneous disease with variable effects on lung parenchyma, airways, and vasculature, leading to long-term effects on lung functions. Materials and Methods: This multicentric, prospective, observational, and interventional study included 1000 COVID-19 cases confirmed with reverse transcription-polymerase chain reaction. All cases were assessed with high-resolution computed tomography thorax, oxygen saturation, inflammatory marker as D-dimer at the entry point, and follow-up. Age, gender, comorbidity, use of bilevel positive airway pressure/noninvasive ventilation (BiPAP/NIV), and outcome as with or without lung fibrosis as per CT severity were key observations. In selected cases, we have performed lower limb venous Doppler and computed tomography (CT) pulmonary angiography to rule out deep-vein thrombosis (DVT) or pulmonary thromboembolism (PTE) respectively. Statistical analysis is performed by using Chi-square test. Observations and Analysis: Age (<50 and >50 years) and gender (male vs. female) has a significant association with D-dimer level (P < 0.00001 and P < 0.010, respectively). CT severity score at the entry point with the D-dimer level has a significant correlation (P < 0.00001). The D-dimer level has a significant association with the duration of illness before hospitalization (P < 0.00001). Comorbidities have a significant association with D-dimer levels (P < 0.00001). D-dimer level has a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement has a significant association with the D-dimer level (P < 0.00001). Timing of BIPAP/NIV requirement during hospitalization has a significant association with D-dimer level (P < 0.00001). Follow-up D-dimer titer during hospitalization as compared to normal and abnormal to entry point level has a significant association with post-COVID lung fibrosis, DVT, and PTE (P < 0.00001). Conclusions: D-dimer has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness and assessing response to treatment during hospitalization, and follow-up titers have a significant role in step-up or step-down interventions in a critical care setting.
Résumé Introducción: La neumonía por enfermedad por coronavirus 2019 (COVID 19) es una enfermedad heterogénea con efectos variables sobre el parénquima pulmonar, las vías respiratorias y la vasculatura, lo que lleva a efectos a largo plazo sobre las funciones pulmonares. Materiales y métodos: este estudio multicéntrico, prospectivo, observacional e intervencionista incluyó 1000 casos de COVID 19 confirmados con reacción en cadena de la polimerasa con transcriptasa inversa. Todos los casos fueron evaluados con tomografía computarizada de tórax de alta resolución, saturación de oxígeno, marcador inflamatorio como dímero D en el punto de entrada y seguimiento. La edad, el sexo, la comorbilidad, el uso de presión positiva en las vías respiratorias de dos niveles/ventilación no invasiva (BiPAP/NIV) y el resultado con o sin fibrosis pulmonar según la gravedad de la TC fueron observaciones clave. En casos seleccionados, hemos realizado Doppler venoso de miembros inferiores y angiografía pulmonar por tomografía computarizada (TC) para descartar trombosis venosa profunda (TVP) o tromboembolismo pulmonar (TEP) respectivamente. El análisis estadístico se realiza utilizando la prueba de Chi cuadrado. Observaciones y análisis: la edad (50 años) y el sexo (hombre vs. mujer) tienen una asociación significativa con el nivel de dímero D (P < 0,00001 y P < 0,010, respectivamente). La puntuación de gravedad de la TC en el punto de entrada con el nivel de dímero D tiene una correlación significativa (P < 0,00001). El nivel de dímero D tiene una asociación significativa con la duración de la enfermedad antes de la hospitalización (P < 0,00001). Las comorbilidades tienen una asociación significativa con los niveles de dímero D (P < 0,00001). El nivel de dímero D tiene una asociación significativa con la saturación de oxígeno (P < 0,00001). El requerimiento de BIPAP/NIV tiene una asociación significativa con el nivel de dímero D (P < 0.00001). El momento del requerimiento de BIPAP/NIV durante la hospitalización tiene una asociación significativa con el nivel de dímero D (P < 0.00001). El título de dímero D de seguimiento durante la hospitalización en comparación con el nivel normal y anormal al punto de entrada tiene una asociación significativa con la fibrosis pulmonar, la TVP y la TEP posteriores a la COVID (P < 0,00001). Conclusiones: el dímero D ha documentado un papel muy importante en la neumonía por COVID 19 para predecir la gravedad de la enfermedad y evaluar la respuesta al tratamiento durante la hospitalización, y los títulos de seguimiento tienen un papel importante en las intervenciones de aumento o reducción en un entorno de cuidados críticos. Mots-clés: Palabras clave: enfermedad por coronavirus 2019, neumonía, dímero D, trombosis venosa profunda, marcador inflamatorio, fibrosis pulmonar, embolia pulmonar.