Documento internacional de consenso sobre apnea obstructiva del sueño / International Consensus Document on Obstructive Sleep Apnea

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

International Consensus Document on Obstructive Sleep Apnea. / Documento internacional de consenso sobre apnea obstructiva del sueño.

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).

Quality Assessment of Real-Life Performance of Home Mechanical Ventilators / Evaluación de la calidad del funcionamiento en vida real de los ventiladores mecánicos domiciliarios

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Conventional Polysomnography Is Not Necessary for the Management of Most Patients with Suspected Obstructive Sleep Apnea. Noninferiority, Randomized Controlled Trial.

RATIONALE: Home respiratory polygraphy may be a simpler alternative to in-laboratory polysomnography for the management of more symptomatic patients with obstructive sleep apnea, but its effectiveness has not been evaluated across a broad clinical spectrum. OBJECTIVES: To compare the long-term effectiveness (6 mo) of home respiratory polygraphy and polysomnography management protocols in patients with intermediate-to-high sleep apnea suspicion (most patients requiring a sleep study). METHODS: A multicentric, noninferiority, randomized controlled trial with two open parallel arms and a cost-effectiveness analysis was performed in 12 tertiary hospitals in Spain. Sequentially screened patients with sleep apnea suspicion were randomized to respiratory polygraphy or polysomnography protocols. Moreover, both arms received standardized therapeutic decision-making, continuous positive airway pressure (CPAP) treatment or a healthy habit assessment, auto-CPAP titration (for CPAP indication), health-related quality-of-life questionnaires, 24-hour blood pressure monitoring, and polysomnography at the end of follow-up. The main outcome was the Epworth Sleepiness Scale measurement. The noninferiority criterion was -2 points on the Epworth scale. MEASUREMENTS AND MAIN RESULTS: In total, 430 patients were randomized. The respiratory polygraphy protocol was noninferior to the polysomnography protocol based on the Epworth scale. Quality of life, blood pressure, and polysomnography were similar between protocols. Respiratory polygraphy was the most cost-effective protocol, with a lower per-patient cost of 416.7€. CONCLUSIONS: Home respiratory polygraphy management is similarly effective to polysomnography, with a substantially lower cost. Therefore, polysomnography is not necessary for most patients with suspected sleep apnea. This finding could change established clinical practice, with a clear economic benefit. Clinical trial registered with www.clinicaltrials.gov (NCT 01752556).

Los trastornos de la respiración durante el sueño, la ventilación no invasiva y los cuidados críticos en ARCHIVOS DE BRONCONEUMOLOGÍA (junio de 2008- noviembre de 2009) / Sleep Respiratory Disorders, Non-Invasive Ventilation and Critical Care in ARCHIVOS DE BRONCONEUMOLOGÍA (June 2008-November 2009)

En el presente estudio, se analizan los trabajos publicados en ARCHIVOS DE BRONCONEUMOLOGÍA de junio de 2008a noviembre de 2009 que hacen referencia a los trastornos del sueño, la ventilación no invasiva y los cuidadoscríticos.La metodología empleada ha sido analizar los objetivos de los trabajos presentados, con sus principalesresultados y las refl exiones que han sugerido a los autores, planteándose muchas veces la posibilidad dedesarrollar nuevos trabajos de investigación.La revisión incluye no sólo los trabajos originales, sino también una refl exión acerca de las editoriales, artículosespeciales y trabajos de revisión(AU)

The present study analyses the works published in ARCHIVOS DE BRONCONEUMOLOGÍA from June 2008 to November2009 that mention sleep disorders, non-invasive ventilation and critical care.The methodology used was to analyse the objectives of the works submitted, with their main results andthe conclusions suggested by the authors, often putting forward the possibility of conducting new researchstudies.The review no only includes original articles but is also a refl ection on the editorials, special articles andreview works(AU)

[Sleep apnea-hypopnea syndrome and the heart]. / Síndrome de apneas-hipopneas durante el sueño y corazón.

Cardiovascular and cerebrovascular diseases are the most common diseases in industrialized societies. The main objectives of this article were to summarize the physiological effects of sleep apnea on the circulatory system and to review how treatment of this condition influences cardiovascular disease. Acute sleep apnea has a number of hemodynamic consequences, such as pulmonary and systemic hypertension, increased ventricular afterload and reduced cardiac output, all of which result from sympathetic stimulation, arousal, alterations in intrathoracic pressure, hypoxia and hypercapnia. When chronic, sleep apnea-hypopnea syndrome is associated with systemic hypertension, ischemic heart disease, congestive heart failure, and Cheyne-Stokes respiration in patients with congestive heart failure. Nocturnal treatment with continuous positive airway pressure decreases both the number of central apneic episodes and blood pressure in patients with sleep apnea-hypopnea syndrome and arterial hypertension.

Síndrome de apneas-hipopneas durante el sueño y corazón / Sleep apnea-hypopnea syndrome and the heart

Las enfermedades cardiovasculares y cerebrovasculares son las más comunes en la sociedad industrial. Los objetivos principales de este trabajo son revisar las consecuencias fisiológicas de la apnea del sueño en el sistema circulatorio y revisar los efectos del tratamiento de esta alteración sobre las enfermedades cardiovasculares. Las apneas durante el sueño producen de forma aguda una serie de consecuencias hemodinámicas que incluyen: hipertensión pulmonar y sistémica, incremento de la poscarga ventricular y disminución del gasto cardiaco, fenómenos todos ellos resultado de la estimulación simpática, del arousal, de las alteraciones en la presión intratorácica y de la hipoxia e hipercapnia. De forma crónica, el síndrome de apneas-hipopneas durante el sueño (SAHS) se ha relacionado con hipertensión arterial sistémica diurna, cardiopatía isquémica, insuficiencia cardiaca congestiva y respiración de Cheyne-Stokes en el fracaso cardiaco congestivo. Se ha observado que el tratamiento con presión positiva continua (CPAP) nasal nocturna sobre la vía aérea superior disminuye el número de apneas centrales y también reduce los valores de presión arterial en pacientes con SAHS e hipertensión arterial

Cardiovascular and cerebrovascular diseases are the most common diseases in industrialized societies. The main objectives of this article were to summarize the physiological effects of sleep apnea on the circulatory system and to review how treatment of this condition influences cardiovascular disease. Acute sleep apnea has a number of hemodynamic consequences, such as pulmonary and systemic hypertension, increased ventricular afterload and reduced cardiac output, all of which result from sympathetic stimulation, arousal, alterations in intrathoracic pressure, hypoxia and hypercapnia. When chronic, sleep apnea-hypopnea syndrome is associated with systemic hypertension, ischemic heart disease, congestive heart failure, and Cheyne-Stokes respiration in patients with congestive heart failure. Nocturnal treatment with continuous positive airway pressure decreases both the number of central apneic episodes and blood pressure in patients with sleep apnea-hypopnea syndrome and arterial hypertension

[Effect on quality of life of nCPAP treatment in patients with obstructive sleep apnea]. / Efecto del tratamiento con presión positiva continua en la vía respiratoria durante la noche en la calidad de vida de los pacientes con apnea del sueño.

BACKGROUND AND OBJECTIVE: The standard treatment of the obstructive sleep apnea syndrome (OSAS) is the nCPAP. There is evidence that its use improves the quality of life of patients. The objective of the study is to measure the effect of nCPAP on the quality of life of patients in a Spanish cohort. PATIENTS AND METHOD: We have used 3 quality of life questionnaires: SF-36, EuroQol 5D and FOSQ. OSAS patients were interviewed at baseline prior to the start of the treatment and at 3 months follow-up. Two measures were employed to analyze the data: distribution based measures such as the effect size and instruments that evaluate the sensitivity to change of the questionnaires such as the ROC curves. RESULTS: We interviewed 124 patients. The benefit in terms of utility of the nCPAP was 0.03 with SF-36 and 0.04 with EuroQol 5D. Effect size varies from small (0.21) with EuroQol 5D to moderate (0.51) with FOSQ. SF-36 obtained intermediate scores (0.35). EuroQol 5D was the questionnaire that obtained the biggest area under the ROC curve. Nevertheless, the area size was small in all cases. CONCLUSIONS: nCPAP improves significantly the quality of life of OSAS patients. The assessment of the quality of life of OSAS patients with the available instruments is only partially satisfactory.

Efecto del tratamiento con presión positiva continua en la vía respiratoria durante la noche en la calidad de vida de los pacientes con apnea del sueño / Effect on quality of life of nCPAP treatment in patients with obstructive sleep apnea

Fundamento y objetivo: La utilización de la presión positiva continua en la vía respiratoria durante la noche (nCPAP) en el tratamiento del síndrome de apneas-hipopneas durante el sueño (SAHS) es una opción terapéutica consolidada. Su uso mejora la calidad de vida de los pacientes. El objetivo de este estudio es medir su efecto sobre la calidad de vida tanto en términos de significación clínica como de utilidades. Pacientes y método: Se han utilizado 3 cuestionarios de calidad de vida: SF-36, EuroQol-5D y FOSQ. Se estudió a los pacientes con SAHS antes del comienzo del tratamiento y 3 meses después. Los resultados se interpretaron mediante medidas basadas en la distribución como el tamaño de efecto y medidas que permiten identificar la sensibilidad de los instrumentos como las curvas de eficacia diagnóstica (curvas ROC). Resultados: El número de pacientes fue de 124. El beneficio del tratamiento en términos de utilidades fue 0,03 medido con el SF-36 y 0,04 con el EuroQol-5D. El tamaño de efecto variaba desde pequeño con EuroQol-5D (0,21) hasta moderado con FOSQ (0,51) y SF-36 (0,35). EuroQol-5D es el cuestionario que produce mayor área bajo la curva ROC. Sin embargo, el tamaño del área es pequeño en todos los casos. Conclusiones: El tratamiento mejora de forma significativa la calidad de vida de los pacientes con SAHS. La medida del impacto del SAHS en las diferentes dimensiones psicosociales y funcionales de la calidad de vida permitiría una mejora del manejo clínico de los pacientes. Sin embargo, es un reto pendiente al que los cuestionarios utilizados en este estudio dan una respuesta limitada

Background and objective: The standard treatment of the obstructive sleep apnea syndrome (OSAS) is the nCPAP. There is evidence that its use improves the quality of life of patients. The objective of the study is to measure the effect of nCPAP on the quality of life of patients in a Spanish cohort. Patients and method: We have used 3 quality of life questionnaires: SF-36, EuroQol 5D and FOSQ. OSAS patients were interviewed at baseline prior to the start of the treatment and at 3 months follow-up. Two measures were employed to analyze the data: distribution based measures such as the effect size and instruments that evaluate the sensitivity to change of the questionnaires such as the ROC curves. Results: We interviewed 124 patients. The benefit in terms of utility of the nCPAP was 0.03 with SF-36 and 0.04 with EuroQol 5D. Effect size varies from small (0.21) with EuroQol 5D to moderate (0.51) with FOSQ. SF-36 obtained intermediate scores (0.35). EuroQol 5D was the questionnaire that obtained the biggest area under the ROC curve. Nevertheless, the area size was small in all cases. Conclusions: nCPAP improves significantly the quality of life of OSAS patients. The assessment of the quality of life of OSAS patients with the available instruments is only partially satisfactory