ABSTRACT
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.
Subject(s)
COVID-19 , Sleep Apnea, Obstructive , Male , Humans , Middle Aged , Aged , Pandemics , Retrospective Studies , Sleep Apnea, Obstructive/therapy , Patient ComplianceABSTRACT
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.
ABSTRACT
RESUMEN Introducción: Debido al aumento de la expectativa y calidad de vida, la población de octogenarios aumentó considerablemente. En Argentina, la información médica concerniente a este grupo de pacientes es escasa. Materiales y métodos: Se trata de un estudio descriptivo y comparativo de corte transversal. Se realizaron comparaciones entre una población octogenaria y no octogenaria, comprendida por adultos mayores entre 60 y 79 años. Se evaluaron los factores de riesgo cardiovascular, el tratamiento farmacológico, los motivos de realización/derivación, hallazgos y criterios de detención de las pruebas ergométricas. Resultados: Se incluyeron 161 pacientes octogenarios (media de edad 82, 98 años). El 94% de los pacientes presentaba algún factor de riesgo cardiovascular. El motivo de derivación más frecuente fue en contexto de un apto físico o control de salud. Hemos observado diferencias esperables entre ambas poblaciones. Los pacientes octogenarios se encontraban recibiendo más tratamiento farmacológico que los demás. No hubo hallazgos de relevancia ni complicaciones durante el estudio. Conclusión: En población octogenaria, la prueba ergométrica constituye una herramienta valiosa por la información que aporta y la ausencia de complicaciones. Probablemente, la subjetividad en la evaluación de la disnea motiva la solicitud de pruebas ergométricas.
SUMMARY Objectives: Due to the increase in life expectancy and quality of life, the population of octogenarians increased considerably. In Argentina, medical information concerning this group of patients is scarce. Methods: Descriptive and comparative cross-sectional study. Comparisons were made between an octogenarian and non-octogenarian population, comprised of older adults between 60 and 79 years. Cardiovascular risk factors, pharmacological treatment, the reasons for completion/referral, findings and criteria for stopping ergometric tests were evaluated. Results: 161 octogenarian patients were included (mean age 82, 98 years). 94% of the patients presented some cardiovascular risk factor. The most frequent reason for referral was in the context of physical fitness or health control. We have observed expected differences between both populations. The octogenarian patients were receiving more pharmacological treatment. There were no relevant findings or complications during the study. Conclusion: In the octogenarian population, ergometric test is a valuable tool given the information it provides and the absence of complications. Probably, the subjectivity in the evaluation of dyspnea motivates the request for ergometric tests.