[Compliance with CPAP treatment in patients with obstructive sleep apneas during the COVID-19 pandemic in two hospitals in the Federal Capital] / Cumplimiento del tratamiento con CPAP en pacientes con apneas obstructivas del sueño durante la pandemia COVID-19 en dos hospitales de Capital Federal.

Introduction: CPAP therapy is the first line treatment for sleep apnea and its effectiveness depends on adherence. Face to face control and follow-up was limited due to the fact that our country was immersed in social isolation due to the COVID-19 pandemic as of March 2020. In order to assess whether CPAP adherence was maintained in patients with obstructive sleep apnea (OSA), in two hospitals during the COVID-19 pandemic and compare it with the pre-pandemic situation on a historical control basis in the city of Buenos Aires. Methods: Observational and retrospective study based on systematic data collection of adherence to CPAP and residual apnea-hypopnea index (AHI). For comparison, a historical control corresponding to the specular period (May to December of each year between 2016 and 2019) was used as a reference. Patients over 18 years ago with OSA on CPAP therapy more than 30 days of treatment were included. Patients with other chronic respiratory diseases requiring ventilation therapy (Bi-level, servo ventilation, volume-assured ventilation) were excluded. Results: 151 pre-pandemic patients and 127 from the pandemic period, respectively, were evaluated. Men 98 (65%) vs. 50 (60.3%) p: 0.9, age: 65.4 ± 11.9 vs. 63.6 ± 12.6 p: 0.22, body mass index 31.5 ± 5.0 vs. 31.2 ± 5.3 kg/m2 p: 0.6, respectively. In both centers, the most used treatment was fixed CPAP; 90 (59.6%) vs. 96 (75.6%) p: 0.005. There was an increase in compliance with it compared to the pre-pandemic period in minutes/night [341.4 95% CI 292.4 - 340.6 vs. 274.3 95% CI 208.5 - 267.4, p: 0.001] and residual AHI reduction [3.3 IC 95% 2.0 - 3.05 vs. 6.3 IC 95% 2.6 - 4.3 p: 0.006]. Conclusions: In the period of the COVID-19 pandemic, greater adherence to CPAP treatment was observed in patients with sleep apnea.

Introducción: La terapia con CPAP es el tratamiento de primera línea para la apnea del sueño y su eficacia depende de la adherencia. El control y seguimiento de forma presencial fue limitado debido a que nuestro país se vio inmerso en aislamiento social debido a la pandemia por COVID-19 a partir de marzo del 2020. Con el objeto de evaluar si se mantuvo la adherencia de la CPAP en pacientes con apnea obstructiva del sueño (AOS), en dos hospitales durante la pandemia COVID-19 y compararlo con la situación prepandemia sobre una base de control histórico de la ciudad de Buenos Aires. Métodos: Estudio observacional y retrospectivo basado en datos de recolección sistemática de adherencia a la CPAP e índice de apnea-hipopnea (IAH) residual. Para la comparación, se utilizó como referencia un control histórico correspondiente al periodo especular (mayo a diciembre de cada año entre el 2016 y 2019). Se incluyeron pacientes de más de 18 años de edad, con AOS con terapia con CPAP de más de 30 días de tratamiento. Se excluyeron pacientes con otras patologías respiratorias crónicas que requerían de terapias de ventilación (Bi-level, servo ventilación, ventilación con volumen asegurado). Resultados: Fueron evaluados 151 pacientes prepandemia y 127 del periodo pandemia respectivamente. Hombres 98 (65%) vs. 50 (60.3%) p: 0.9, edad de 65.4± 11.9 vs 63.6 ± 12.6 p: 0.22, índice de masa corporal 31.5 ± 5.0 vs. 31.2 ± 5.3 kg/m2 p: 0.6, respectivamente En ambos centros, el tratamiento más utilizado fue CPAP fijo; 90 (59.6%) vs. 96 (75.6%) p: 0.005. Existió un aumento en el cumplimiento del mismo en comparación al periodo prepandémico en minutos/noche [341.4 IC 95% 292.4 - 340.6 vs. 274.3 IC 95% 208.5 - 267.4, p: 0.001] y reducción del IAH residual [3.3 IC 95% 2.0 - 3.05 vs. 6.3 IC 95% 2.6 - 4.3 p: 0.006]. Conclusiones: En el periodo de pandemia COVID-19 se observó mayor adherencia al tratamiento con CPAP en pacientes con apneas del sueño.

Nocturnal Polysomnography without Technical Supervision in the Diagnosis of Respiratory Sleep Disorders, Diagnostic Performance of Home and Sleep Laboratory Studies.

Introduction Unattended Polysomnography (type 2 PSG) is a procedure for the diagnosis of sleep-disordered breathing (SDB). Published evidence on its performance and efficacy is limited. Available studies reveal a high rate of lost records that could limit its application. Objective To assess the efficacy of type 2 PSG and the rate of studies that must be repeated due to critical loss of signals. Methods prospective, descriptive study. Adult patients with suspected SDB were included. Unattended PSG was performed using portable equipment. 75 patients were connected at home and another 75 in the laboratory, without subsequent monitoring. Records were evaluated to determine the percentage of the night with adequate quality for each of the signals, considered as an evaluable signal for = 70% of the total recording time (TRT). The need to repeat the studies was also estimated. Results: 150 patients were recruited; 44% women; age 57.3 ± 15.4 years; BMI 29.4 ± 6.5. EEG and EOG signals were adequate in 149 records. Flow signal by pressure cannula was adequate in 146 and by thermistor in 67.8%. In only one study the signal of both effort bands were inadequate. Oximetry was lost in 4 cases. Ten tracings (6%) met the criteria for repetition; 8 hospital and 2 home. Conclusions Acceptable records were obtained in most unattended PSG studies, both at home and in the sleep laboratory. The rate of repetition of studies due to loss of signal was 6%, with failure in SaO2 or in flow signals being the main cause of the indication.

Frequency of use and preferences for information and communication technologies in patients with sleep apnea: A multicenter, multinational, observational cross-sectional survey study.

BACKGROUND: Obstructive sleep apnea (OSA) is a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep. An accessible method to facilitate self-management education is through information and communication technologies (ICTs). PURPOSE: To assess the frequency of and preferences for ICT use in patients with sleep apnea. METHODS: A multicenter, multinational, observational cross-sectional survey study was conducted between 2018 and 2019 in sleep units in different countries of Latin America, including patients of both genders older than 18 years with a diagnosis of sleep apnea. Participants were asked to complete 20 questions in a self-administered survey about the frequency of use of ICTs and their preferences for receiving disease-related information. RESULTS: A total of 435 patients participated in the study, with a mean age of 59.1 ± 14.0; 62.5% (n = 272) were males. Most patients had access to cellphones (92.4%, n = 402), smartphone (83.0%, n = 361) and an internet connection (82.3%, n = 358). One-to-one ICTs were regarded as the most frequently used ICT type, as 75.4% (n = 328) of participants reported using them daily (χ2(4) = 848.207, p =.000). With respect to categories of interest, one-to-one ICTs were also the best rated ICT type to receive (59.1%, n = 257; χ2(2) = 137.710, p =.000) and ask physicians (57.0%, n = 248; χ2(2) = 129.145, p =.000) information about OSA. Finally, older adults and those with lower educational levels were found to be less likely to use and be interested in ICTs. CONCLUSION: Most patients have access to different ICTs and often use them to seek and receive medical information. The preferred ICTs include those in the one-to-one category (WhatsApp, email) and the one-to-many category (web browsers) for general health and OSA-related information.

Access to CPAP treatment in patients with moderate to severe sleep apnea in a Latin American City.

INTRODUCTION: The most effective treatment for moderate to severe obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP) but adherence may be a limiting factor. Most compliance studies often only include patients under CPAP treatment, neglecting the importance of access to treatment. The aim of this study was to evaluate CPAP access and compliance in OSA patients, after CPAP indication and titration. METHODS: We included moderate to severe OSA patients, diagnosed by in-lab polysomnography (PSG), with CPAP indication and effective pressure titration. Between 12 to 18 months after treatment was indicated a telephone questionnaire was administered including questions about access to CPAP, reasons of no access, reported adherence and symptoms improvement. RESULTS: A total of 213 patients responded to the survey (171 males, mean age 53.4±13.5 and BMI 34.02±8.8 kg/m2). Almost a third of the patients (28.2%) did not initiate CPAP treatment. Out of 213, 153 patients (71.8%) started treatment with CPAP and 120 (56.3%) reported still being under treatment a year after indication, additionally, 85.8% reported that they were using it =4hs/night. Those who accessed to CPAP were on average, older age, had full coverage of treatment by their medical insurance, required lower effective pressure and experienced more severe sleepiness compared to those individuals who did not accessed to CPAP. DISCUSSION: A significant proportion of OSA patients with CPAP indication did not initiate and/or eventually abandoned CPAP. Approximately only 50% of the patients were still under treatment, with acceptable self-reported adherence rate and clinical response, one year after the initial treatment indication. Additional measures are necessary to increase access to CPAP and improve long-term compliance.

The Impact of Age and Comorbidities on the Mortality of Patients of Different Age Groups Admitted with Community-acquired Pneumonia.

RATIONALE: Comorbidities, age, severity of illness, and high risk pathogens are well-known outcome determinants in community-acquired pneumonia (CAP). How these factors interact has not yet been clarified. OBJECTIVES: We conducted this study to analyze the complex interaction of comorbidities, age, illness severity, and pathogens in relation to CAP. METHODS: We performed a secondary analysis of the Community-Acquired Pneumonia Organization database to evaluate the impact of age in different age groups (<65, 65-79, and ≥80 yr), comorbidities (malignant disease, chronic obstructive pulmonary disease, renal and liver disease, cerebrovascular accident, congestive heart failure, and diabetes mellitus), severity of illness at admission, and etiology on the mortality of patients admitted to the hospital with CAP. MEASUREMENTS AND MAIN RESULTS: A total of 6,205 patients met the inclusion criteria, and 508 (8.2%) died within 30 days. Factors independently associated with mortality were malignant disease, congestive heart failure, cerebrovascular accident, renal disease, diabetes mellitus, altered mental status, hypoxemia, pleural effusion, hematocrit less than 30%, requirement for mechanical ventilation, and being age 80 years and older. A total of 1,699 pathogens were defined in 1,545 cases; the etiology was the same for all age groups. In the overall population, mortality increased with age, but etiology was not associated with mortality. When we analyzed the patients with one comorbidity or less, we found that mortality was not different between patients younger than 65 old and those 65-79 years old, but it was higher for those aged 80 years and older. CONCLUSIONS: The presence of comorbidities is associated with poorer outcomes in CAP. However, when one comorbidity or less was present, we found that being age 80 years or older was a factor that increased mortality. From a clinical standpoint, this study suggests that being age 80 years or older, instead of age 65 years and older, should be considered a risk factor for poor outcome in CAP.

Evolución de la función pulmonar en la enfermedad intersticial pulmonar asociada a esclerodermia tratada con ciclofosfamida: Análisis retrospectivo de una serie de casos en un hospital universitario / Evolution of Pulmonary Function in Scleroderma-Associated Interstitial Lung Disease Treated with Cyclophosphamide: Retrospective Study of a Case Series in a School Hospital

Introducción: La ciclofosfamida (CYC) es utilizada frecuentemente para el tratamiento de la Intersticiopatía asociada a Esclerodermia (ES-EPID), a pesar de su limitada eficacia. El objetivo primario fue evaluar cambios en la función pulmonar en pacientes tratados con CYC en ES-EPID. Métodos: Se estudiaron retrospectivamente 24 pacientes con ES-EPID que asistieron al consultorio de neumonología del Hospital de Clínicas, Buenos Aires, Argentina. De los 24 pacientes, 18 tenían ES-EPID extensa, definida como extensión mayor 30% en Tomografía computada o Capacidad vital forzada (FVC) menor 70%, y de éstos, 12 fueron tratados con CYC, mientras que los 6 pacientes con enfermedad limitada no recibieron tratamiento. Se recabaron datos de FVC y Difusión de monóxido de carbono (DLCO) pre y post tratamiento. Resultados: Entre los 12 pacientes incluidos, la FVC (litros) pre tratamiento fue de 2.25 ± 0.51, (75.6 ± 15.3% del predicho), mientras que luego de una mediana de 9 meses era de 2.14 ± 0.50; (71.9 ± 14.1%) (p: 0.17). Se encontró además, un descenso no significativo de la DLCO (ml/mmHg/min) luego del tratamiento, descendiendo de 9.03 ± 1.68, a 8.39 ± 1.31 (p: 0.29). Conclusión: El tratamiento con CYC de ES-EPID extensa no se asoció con mejoría significativa, aunque si con estabilidad de la función pulmonar tras una mediana de 9 meses de tratamiento.

Introduction: In spite of its limited efficacy, cyclophosphamide (CYC) is frequently used to treat scleroderma-associated interstitial lung disease (SSc-ILD). The primary objective of this study was to evaluate changes in pulmonary function in SSc-ILD patients treated with CYC. Materials and Methods: 24 SSc-ILD outpatients from the Pneumonology Department of the Hospital de Clínicas in Buenos Aires, Argentina were studied retrospectively. Out of the 24 patients, 18 had extensive SSc-ILD, defined as disease extent on CT greater than 30% or FCV less than 70%; 12 of them were treated with CYC while the remaining 6 with limited disease did not receive treatment. Forced vital capacity (FVC) and carbon monoxide diffusing capacity (DLCO) data were collected both before and after treatment. Results: Among the 12 patients included, the FVC before and after the 9 month treatment was 2.25±0.51 (75.6±15.3% of the predicted value) and 2.14±0.50; (71.9±14.1%) (p: 0.17) respectively. In addition, a non-significant decrease in DLCO (ml/mmHg/min) was found after treatment (from 9.03 ±1.68 to 8.39 ± 1.31 (p: 0.29)). Conclusion: Although the 9 month treatment of extensive SSc-ILD with CYC did not show significant improvement, pulmonary function was stabilized.

Una causa poco frecuente de hemoptisis / A rare cause of hemoptysis

Se trata de una paciente de 61 años de edad, con antecedentes de tabaquismo leve (5 paquetes/año), diabetes tipo 2 (insulino requiriente), hipertensión arterial y obesidad, que consultó por hemoptisis de 1 año de evolución. Este síntoma se presentaba en forma intermitente, sin asociación con fiebre ni pérdida de peso. Previamente se había realizado una TAC de tórax que no revelaba lesiones y una fibrobroncoscopía donde se observaba sangre roja en lóbulo inferior derecho, aunque sin lesiones endobronquiales; el cultivo del BAL resultó negativo para gérmenes comunes y BAAR

Neumonía grave de la comunidad (NGC), 145 casos internados en terapia intensiva / Severe community acquired pneumonia (SCAP), 145 cases admitted to the intensive care unit

Objetivos: analizar la epidemiología, mortalidad y factores asociados a la presencia de neumonía grave de la comunidad (NGC). Métodos: análisis de datos de pacientes internados por neumonía durante 6 años. Resultados: 145/687 (21.1%) pacientes internados por Neumonýa Aguda de la Comunidad (NAC) tenían NGC, 71 eran varones; la edad media fue 71 ± 16; 85 recibieron asistencia respiratoria mecánica (ARM); en 67 se determinó la etiología (S. pneumoniae 46.3%, P. aeruginosa 12.8%; S. aureus 11.5%, polimicrobiana 26.9%); la mortalidad global fue 45.5%. Se relacionaron significativamente con la mortalidad: la ARM, score de Glasgow ú 14, PaO2/FIO2 < 250, patógeno gram-negativo (no Haemophilus), S. aureus, infección polimicrobiana, tensión arterial sistólica < 90 mmHg, derrame pleural, y frecuencia respiratoria > 30/min y se relacionó negativamente un patógeno atípico (excluyendo Legionella). En el análisis multivariado solo permanecieron relacionados con la mortalidad los primeros 4 factores arriba mencionados; los odds ratio y los intervalos de confianza (IC 5-95%) fueron respectivamente: 6.04 (5.16 - 6.91); 2.30 (1.49 - 3.11); 2.64 (1.73 - 3.55); 4.49 (3.08 - 5.89). Pacientes con bajos scores del índice de gravedad de neumonía (PSI) y CURB-65 fueron internados en la UTI y mostraron una mortalidad mayor a la observada en los que se internaron en una sala general. La internación en la UTI luego de las primeras 24 horas (tardíamente) mostró una tendencia a mayor mortalidad. La mayoría de los pacientes internados en forma temprana y todos los internados tardíamente cumplían los criterios de las normas de la ATS sobre NGC. Discusión: La NGC tiene alta mortalidad y epidemiología diferente. Es conocido que el tratamiento debe ser efectivo y precoz teniendo en cuenta los patógenos probables. El examen clínico, los gases en sangre y la radiografía permiten identificar al ingreso unmayor riesgo de muerte. Muchos de los hallazgos habitualmente considerados ... (AU)

Objectives: to analyze the epidemiology, mortality rate and associated risk factors in SCAP. Methods: secondary analysis from the data of the patients admitted for Community-Acquired Pneumonia (CAP) during the last 6 years. Results: 145/687 (21.1%) patients admitted for CAP had SCAP; there were 71 males; mean age was 71 ± 16; 85 patients received mechanical ventilation (MV); in 67 the etiology was identified (S. pneumoniae 46.3%, P. aeruginosa 12.8%; S. aureus 11.5%,polimicrobial 26.9%); mortality rate was 45.5%. Variables significantly associated with mortality were: MV, Glasgow coma score ú 14, PaO2/FIO2 < 250, a gram-negative pathogen(excluding Haemophilus), S. aureus, polimicrobial etiology, systolic arterial pressure < 90 mmHg, pleural effusion; while it was negatively associated with the presence of an atypical pathogen (excluding Legionella). In the multivariate analysis only the 4 firstabove mentioned factors remained related with mortality; the odds ratios and confidence intervals (CI 5-95%) were respectively: 6.04 (5.16 - 6.91); 2.30 (1.49 - 3.11); 2.64 (1.73 - 3.55); 4.49 (3.08 - 5.89). Some patients with low class pneumonia severity indexand CURB-65 scores who were admitted into the ICU, presented a higher mortality rate than that observed in those admitted into a general ward. ICU admission after the first 24 hours was associated with a trend towards higher mortality rate. All those patients admitted late met the severity criteria recommended by the ATS guidelines. Discussion: SCAP has high mortality rate and a different epidemiology. It is well known that therapy should be administered early and addressed to be effective against the probable pathogens. Clinical exam, blood gases and chest X-ray help to recognize agreater risk of death. A number of facts commonly considered to predict mortality were not confirmed in this study.(AU)

Neumonía grave de la comunidad (NGC), 145 casos internados en terapia intensiva / Severe community acquired pneumonia (SCAP), 145 cases admitted to the intensive care unit

Objetivos: analizar la epidemiología, mortalidad y factores asociados a la presencia de neumonía grave de la comunidad (NGC). Métodos: análisis de datos de pacientes internados por neumonía durante 6 años. Resultados: 145/687 (21.1%) pacientes internados por Neumonìa Aguda de la Comunidad (NAC) tenían NGC, 71 eran varones; la edad media fue 71 ± 16; 85 recibieron asistencia respiratoria mecánica (ARM); en 67 se determinó la etiología (S. pneumoniae 46.3%, P. aeruginosa 12.8%; S. aureus 11.5%, polimicrobiana 26.9%); la mortalidad global fue 45.5%. Se relacionaron significativamente con la mortalidad: la ARM, score de Glasgow £ 14, PaO2/FIO2 < 250, patógeno gram-negativo (no Haemophilus), S. aureus, infección polimicrobiana, tensión arterial sistólica < 90 mmHg, derrame pleural, y frecuencia respiratoria > 30/min y se relacionó negativamente un patógeno atípico (excluyendo Legionella). En el análisis multivariado solo permanecieron relacionados con la mortalidad los primeros 4 factores arriba mencionados; los odds ratio y los intervalos de confianza (IC 5-95%) fueron respectivamente: 6.04 (5.16 - 6.91); 2.30 (1.49 - 3.11); 2.64 (1.73 - 3.55); 4.49 (3.08 - 5.89). Pacientes con bajos scores del índice de gravedad de neumonía (PSI) y CURB-65 fueron internados en la UTI y mostraron una mortalidad mayor a la observada en los que se internaron en una sala general. La internación en la UTI luego de las primeras 24 horas (tardíamente) mostró una tendencia a mayor mortalidad. La mayoría de los pacientes internados en forma temprana y todos los internados tardíamente cumplían los criterios de las normas de la ATS sobre NGC. Discusión: La NGC tiene alta mortalidad y epidemiología diferente. Es conocido que el tratamiento debe ser efectivo y precoz teniendo en cuenta los patógenos probables. El examen clínico, los gases en sangre y la radiografía permiten identificar al ingreso unmayor riesgo de muerte. Muchos de los hallazgos habitualmente considerados ...

Objectives: to analyze the epidemiology, mortality rate and associated risk factors in SCAP. Methods: secondary analysis from the data of the patients admitted for Community-Acquired Pneumonia (CAP) during the last 6 years. Results: 145/687 (21.1%) patients admitted for CAP had SCAP; there were 71 males; mean age was 71 ± 16; 85 patients received mechanical ventilation (MV); in 67 the etiology was identified (S. pneumoniae 46.3%, P. aeruginosa 12.8%; S. aureus 11.5%,polimicrobial 26.9%); mortality rate was 45.5%. Variables significantly associated with mortality were: MV, Glasgow coma score £ 14, PaO2/FIO2 < 250, a gram-negative pathogen(excluding Haemophilus), S. aureus, polimicrobial etiology, systolic arterial pressure < 90 mmHg, pleural effusion; while it was negatively associated with the presence of an atypical pathogen (excluding Legionella). In the multivariate analysis only the 4 firstabove mentioned factors remained related with mortality; the odds ratios and confidence intervals (CI 5-95%) were respectively: 6.04 (5.16 - 6.91); 2.30 (1.49 - 3.11); 2.64 (1.73 - 3.55); 4.49 (3.08 - 5.89). Some patients with low class pneumonia severity indexand CURB-65 scores who were admitted into the ICU, presented a higher mortality rate than that observed in those admitted into a general ward. ICU admission after the first 24 hours was associated with a trend towards higher mortality rate. All those patients admitted late met the severity criteria recommended by the ATS guidelines. Discussion: SCAP has high mortality rate and a different epidemiology. It is well known that therapy should be administered early and addressed to be effective against the probable pathogens. Clinical exam, blood gases and chest X-ray help to recognize agreater risk of death. A number of facts commonly considered to predict mortality were not confirmed in this study.