Evaluación de riesgo de apnea obstructiva del sueño y de la adherencia al tratamiento farmacológico en pacientes con hipertensión arterial / Risk assessment of obstructive sleep apnea and adherence to pharmacological treatment in patients with arterial hypertension

Introducción:existe una sospecha sobre la relación bidireccional entre la apnea obstructiva del sueño (AOS) y la hipertensión arterial (HTA). Ambas ejercen una acción sinérgica sobre desenlaces cardiovasculares porlo quees trascendente ponderar la prevalencia de riesgo para AOS en los hipertensos. En este último grupo también hemos investigado la tasa de adherencia a los fármacos prescritos. Metodología:mediante un estudio de casos y controles y con la aplicación del cuestionario STOP-BANG se han discriminado las categorías de riesgo para apnea de sueño en las dos cohortes. Para el análisis de la adherencia a fármacos antihipertensivos se utilizó el cuestionario abreviado de Morisky. Resultados:se incluyeron a 590 individuos (295 casos y 295 controles. Se observó alto riesgo para AOS en el grupo de hipertensos (36,6%) comparado con el 14,2% del grupo control. Por otro lado, el sexo masculino OR 7,77 (IC95% 4,33-13,84), la obesidad OR 5,03 (IC95% 3,11-8,13) y la HTA OR 4,31 (IC95% 2,64-7,03) se ponderan significativos en un modelo de ajuste logístico aquí estudiado. El 61,69% de los hipertensos refería adherencia al tratamiento farmacológico prescrito. Discusión:el tamizaje de AOS es factible con un cuestionario aplicable en la práctica clínica diaria. De la probabilidad clínica pre-test hay que partir hacia métodos diagnósticos específicos para el diagnóstico de AOS, enfatizando casos de HTA resistente, HTA nocturna y HTA enmascarada. Se deberían realizar estudios locales que nos ayuden a comprender las causas de la falta de adherencia a fármacos antihipertensivos en una fracción importante de los individuos con HTA

Introduction:there is a suspicion about the bidirectional relationship between obstructive sleep apnea (OSA) and arterial hypertension (AHT). Both have a synergistic action on cardiovascular outcomes, so it is important to assess the prevalence of risk for OSA in hypertensive patients. In this last group we have also investigated the rate of adherence to prescribed drugs.Metodology:through a case-control study and with the application of the STOP-BANG questionnaire, the risk categories for sleep apnea in the two cohorts have been discriminated. For the analysis of adherence to antihypertensive drugs, the abbreviated Morisky questionnaire was used. Results:590 individuals were included (295 cases and 295 controls. A high risk for OSA was observed in the hypertensive group (36.6%) compared to 14.2% in the control group. On the other hand, the male sex OR 7.77 (95%CI 4.33-13.84), obesity OR 5.03 (95%CI 3.11-8.13) and hypertensionOR4.31(95%CI 2.64-7.03) they areweighted significant in a logistic adjustment model studied here.61.69% of hypertensive patients reported adherence to the prescribed pharmacological treatment.Discussion:OSA screening is feasible with a questionnaire applicable in daily clinical practice. From the pre-test clinical probability, specific diagnostic methods for the diagnosis of OSA must be started, emphasizing cases of resistant AHT, nocturnal AHT, andmasked AHT. Local studies should be carried out to help us understand the causes of non-adherence to antihypertensive drugs in a significant fraction of individuals with AHT

Adaptación transcultural y validación del cuestionario STOP-bang del inglés al español como herramienta de detección precoz del síndrome de apnea del sueño en el paciente quirúrgico y en la población general / Cross-cultural adaptation and Validation of the STOP-bang Questionnaire from English to Spanish as a tool for the early detection of sleep apnea syndrome in the surgical patient and in the general population

Introduccion: El síndrome de apnea obstructiva del sueño (SAOS) o síndrome de apnea-hipoapnea (SAHS) es uno de los trastornos del sueño más prevalentes en la población general. Está asociado a un aumento en la prevalencia de intubación orotraqueal difícil y de las complicaciones postoperatorias. Se recomienda la aplicación de tests de detección precoz validados como el test en inglés de STOP-bang (STBC); un test de alta calidad metodológica, sensibilidad y especificidad en la detección precoz del SAHS tanto en la población quirúrgica como general. Objetivo: La validación, traducción y adaptación cultural del test STBC a la población española. Material y metodos: Se realizó la adaptación transcultural del STBC al español y un estudio de validación posterior con 77 pacientes consecutivos. El análisis estadístico evaluó la fiabilidad, la validez y la factibilidad de la versión traducida y adaptada culturalmente. Resultados: Se incluyeron el 44% de mujeres y el 56% de varones con una edad media de 53,58±12,88 años. Los resultados en la fiabilidad fueron: un coeficiente alfa de Cronbach de 0,767, una correlación de Pearson r=0,777 (p<0,001) y una correlación de Sperman rho=0,455 (p=0,044). La factibilidad del estudio fue del 100%. La validez de criterio se evaluó mediante el coeficiente Kappa que fué de 0,444. Para una puntuación >3 del cuestionario adaptado al español los resultados de sensibilidad y de especificidad según los distintos niveles de corte del índice apnea hipoapnea (IAH)>5, >15 y >30) fueron: sensibilidad del 87, 91 y 100%, respectivamente, y de especificidad del 50, 31 y 22%, respectivamente.(AU)

Introduction: Obstructive sleep apnea syndrome (OSAS) or apnea-hypoapnea syndrome (SAHS) is one of the most prevalent sleep disorders in the general population. It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications. The application of validated early detection tests,such the STOP-Bang test in English (STBC), is recommended; a test of high methodological quality, sensitivity and specificity in the early detection of SAHS in both surgical and general populations. Objective: The validation, translation, cross-cultural adaptation of the STBC to the Spanish population. Material and methods: The transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out. The statistical analysis evaluated the reliability, validity and feasibility of the translated and culturally adapted version. Results: 44% of women and 56% of men were included,with a mean age of 53.58±12.88 years. The reliability results were: a Cronbach's Alpha Coefficient of 0.767, a Pearson correlation r=.777 (P<.001) and a Sperman correlation rho=.455 (P=.044). The feasibility of the study was 100%. Criterion validity was evaluated using the Kappa coefficient, which was 0.444. For a score >3 of the questionnaire adapted to Spanish, the results of sensitivity, specificity according to the different cut-off levels of the apnea hypopnea index (AHI)>5, >15, >30) were: Sensitivity 87%, 91% and 100% respectively and Specificity of 50%, 31% and 22%. Conclusions: The STBC questionnaire translated, adapted and validated into Spanish, evaluated in the present study, is reliable and valid with respect to the original design of the questionnaire. It is a useful tool that is easy to understand and implement, which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS.(AU)

Cross-cultural adaptation and validation of the STOP-bang Questionnaire from English to Spanish as a tool for the early detection of sleep apnea syndrome in the surgical patient and in the general population.

INTRODUCTION: Obstructive Sleep Apnea Syndrome (OSAS) or Apnea-Hypoapnea Syndrome (SAHS) is one of the most prevalent sleep disorders in the general population. It is associated with an increase in the prevalence of difficult orotracheal intubation and postoperative complications. The application of validated early detection tests, such the STOPbang test in English (STBC), is recommended; a test of high methodological quality, sensitivity and specificity in the early detection of SAHS in both surgical and general populations. OBJECTIVE: The validation, translation, cross-cultural adaptation of the STBC to the Spanish population. MATERIAL AND METHODS: The transcultural adaptation of the STBC to Spanish was carried out and a subsequent validation study with 77 consecutive patients was carried out. The statistical analysis evaluated the reliability, validity and feasibility of the translated and culturally adapted version. RESULTS: 44% of women and 56% of men were included, with a mean age of 53.58 ± 12.88 years. The reliability results were: a Cronbach's Alpha Coefficient of 0.767, a Pearson correlation r = 0.777 (P < .001) and a Sperman correlation rho = 0.455 (P = .044). The feasibility of the study was 100%. Criterion validity was evaluated using the Kappa coefficient, which was 0.444. For a score >3 of the questionnaire adapted to Spanish, the results of sensitivity, specificity according to the different cut-off levels of the apnea hypopnea index (AHI) >5, >15, >30) were: Sensitivity 87%, 91% and 100% respectively and Specificity of 50%, 31% and 22%. CONCLUSIONS: The STBC questionnaire translated, adapted and validated into Spanish, evaluated in the present study, is reliable and valid with respect to the original design of the questionnaire. It is a useful tool that is easy to understand and implement, which can be used rigorously to stratify surgical risk and carry out adequate perioperative planning of those patients at risk of SAHS.

[Blood pressure and sleep apnoea hypopnoea syndrome in workers. STOP-Bang test versus Epworth test]. / Presión arterial y síndrome de apnea-hipopnea del sueño en trabajadores. Test STOP-Bang frente a la escala de Epworth.

INTRODUCTION: OSAHS is associated with an increased risk of cardiovascular disease and stroke. Arterial hypertension is a key risk factor to consider due to its impact on health. METHOD: Cross-sectional study carried out on Spanish public service workers. The nocturnal apnoea risk using the Epworth and STOP-Bang questionnaires and their influence on the mean values of blood pressure are assessed. RESULTS: The detection of OSAHS using the Epworth test and, particularly with the STOP-Bang shows a significant relationship with the mean values of blood pressure, with differences between both questionnaires. CONCLUSION: The Epworth and STOP-Bang questionnaires are useful for the initial detection of OSAHS and a higher prevalence of high blood pressure. Both can be used in screening procedures in occupational health.

Cardiovascular risk and obesity in sleep apnea syndrome assessed with the Stop-Bang questionnaire. / Riesgo cardiovascular y obesidad en el síndrome de apnea del sueño valorado con el cuestionario Stop-Bang.

INTRODUCTION: Sleep disorders include a number of different processes, of which the most prevalent is the sleep apnea-hypopnea syndrome (SAHS). Prevalence of SAHS has increased worldwide, and has a significant social and health impact because of the increased cardiometabolic risk attributed to obesity and the associated metabolic syndrome. MATERIAL AND METHODS: A cross-sectional epidemiological study of 1110 workers from public service companies in the Spanish Mediterranean area (Balearic Islands and Valencian Community) was conducted between January and December 2015. Cardiovascular risk was calculated using the Castelli, Kannel and TG/HDL indices, and prevalence of obesity using body mass index, waist circumference, waist-height ratio, and visceral fat. SAHS risk was assessed using the Stop-Bang questionnaire. RESULTS: Risk of SAHS was low in 77% of patients and intermediate-high in 23% of patients. All obesity parameters showed a statistically significant association (p value <.001) with intermediate/high risk of SAHS. Obesity prevalence is higher the worse the quality of sleep. There was a statistically significant relationship between risk of SAHS and cardiovascular risk with the atherogenic indexes found. CONCLUSIONS: Twenty-three percent of workers had intermediate/high SAHS risk. The results of this study support the relationship of SAHS with an increased CVR and with obesity parameters. Further prospective studies in different productive sectors may be useful to confirm the results of this research.

Escala de Epwoth y cuestionario de Stop Bang como predictores del síndrome de apneas hipopneas obstructivas del sueño / Epworth Sleepiness Scale and Stop Bang questionnaire as predictors for the obstructive sleep apnea syndrome / Escala de Epworth e questionário PARAR BANG como preditores de hipopnéias apneia obstrutiva do sono. Síndrome do sono

Introducción: El SAHOS (Síndrome de Apneas e Hipopneas Obstructivas del Sueño) surge de apneas e hipopneas que generan una hipoxia intermitente. La polisomnografía es el gold standard para su diagnóstico. La Escala de Somnolencia de Epworth (ESS) identifica pacientes con somnolencia diurna. El cuestionario Stop Bang reconoce pacientes con riesgo de SAHOS. El objetivo es describir la sensibilidad y especificidad de la ESS y Stop Bang para el diagnóstico de SAHOS realizado con polisomnografía. Métodos: 125 pacientes completaron la ESS, Stop Bang y realizaron una polisomnografía de noche completa. Se confeccionaron dos grupos: pacientes con IAH < 15, y pacientes con IAH ≥ 15. Se calcularon sensibilidad, especificidad, razón de probabilidades (OR) y curvas ROC para el diagnóstico de SAHOS de la ESS y el Stop Bang. Resultados: La prevalencia del grupo IAH ‹ 15 fue de 36%, y del grupo IAH ≥ 15 fue de 64%. Para la ESS, 71 pacientes presentaron somnolencia diurna, 49,3% con un IAH < 15 y 50,7% con un IAH ≥ 15. Especificidad 77,78%, sensibilidad 55%, área bajo la curva ROC 0,6553. Para el cuestionario Stop Bang, 110 pacientes presentaron alto riesgo para SAHOS, 30% con un IAH < 15 y 70% con IAH ≥ 15. Especificidad 26,67%, sensibilidad 96,25%, área bajo la curva ROC 0,7671. Se enfrentaron ambos cuestionarios y calcularon sus OR: ESS, OR=1,1014 (p=0,038); Stop Bang, OR=8,099 (p=0,002). Conclusiones: La sensibilidad de ESS es baja y su área bajo la curva ROC poco significativa. La gran sensibilidad del cuestionario Stop Bang junto con su área bajo la curva ROC, lo convierten en una herramienta de importancia para realizar screening de SAHOS.

Introduction: osa (obstructive sleep apnea) arises from apneas and hypopneas that cause intermittent hypoxia. Polysomnography is the gold standard for its diagnosis. The Epworth Sleepiness Scale (ESS) measures daytime sleepiness. The Stop Bang Questionnaire (SBQ) recognizes patients at risk of OSA. Objectives: describe the sensitivity and specificity of the ESS and SBQ for the diagnosis of OSA accomplished by polysomnography. Methods: 125 adult patients completed the ESS, SBQ and a full night polysomnography. Patients were grouped into two: those with AHI < 15 and those with AHI ≥ 15. Sensibility, specificity, odds ratio (OR) and ROC curves were determined for the ESS and SBQ. Results: The group with AHI ≥ 15 prevailed (64%). 71 patients (56.8%) showed an abnormal ESS´s score; 49.3% showed an AHI < 15 and 50.7% AHI ≥ 15. The specificity was 77.78% and sensitivity 55%. The area under the ROC curve was 0.6553. Regarding the SBQ, 110 patients were within the high risk group; 30% corresponded to an AHI < 15 and 70% AHI ≥ 15. The specificity was 26.67% and sensitivity 96.25%. The area under the ROC curve was 0.7671. The OR for the ESS was 1.1014 (p=0.038) and SBQ, OR = 8.099 (p=0.002). Conclusion: The sensitivity of the ESS is low and the area under the ROC curve insubstantial. The SBQ shows high sensitivity and a remarkable area under the ROC curve, which turn it into an important tool for screening OSA.

Introdução: sahos (síndrome da apneia e hipopneia obstrutiva do sono) surge de apnéias e hipopnéias que geram hipóxia intermitente. A polissonografia (PSG) é o gold standard para o diagnóstico. A Escala de Sonolência de Epworth (ESS) identifica pacientes com sonolência diurna. O questionário Stop bang reconhece pacientes em risco de doenca de SAHOS. O objetivo de este trabalho é descrever a sensibilidade e especificidade da ESS e do questionario Stop Bang para diagnóstico de SAHOS feito coma PSG. Métodos: 125 pacientes completaram a ess, o stop bang efisseram uma psg con oximetria de noite completa. Dividiram-se os pacientes em dois grupos: com IAH < 15 e 50,7% com um IAH ≥ 15. A especificidade foi de 77,78%, a sensibilidade de 55%, e a área abaixo da curva ROC 0,6553. Enquanto ao questionário stop bang, 110 pacientes apresentaram alto risco de SAHOS, 30% com um IAH < 15 e 70% com IAH ≥ 15. Especificidade de 26,67%, 96,25% de sensibilidade, e 0,7671 da área abaixo da curva. Se comparam ambos questionários e foi calculada sua OR: ESS, OR = 1,1014 (p = 0,038); Stop Bang, OR = 8,099 (p = 0,002). Conclusões: a sensibilidade ess é baixa e a área baixo da curva roc insignificante. A alta sensibilidade do questionário Stop Bang junto com a área baixo da curva ROC o tornam uma ferramenta muito importante para o sreening de esta doença.