Increased incidence of nonfatal cardiovascular events in stroke patients with sleep apnoea: effect of CPAP treatment.

Obstructive sleep apnoea (OSA) is a risk factor for stroke, but little is known about the effect of OSA and continuous positive airway pressure (CPAP) on the incidence of long-term, nonfatal cardiovascular events (CVE) in stroke patients. A prospective observational study was made in 223 patients consecutively admitted for stroke. A sleep study was performed on 166 of them. 31 had an apnoea/hypopnoea index (AHI) <10 events · h(-1); 39 had an AHI between 10 and 19 events · h(-1) and 96 had an AHI ≥ 20 events · h(-1). CPAP treatment was offered when AHI was ≥ 20 events · h(-1). Patients were followed up for 7 yrs and incident CVE data were recorded. The mean ± SD age of the subjects was 73.3 ± 11 yrs; mean AHI was 26 ± 16.7 events · h(-1). Patients with moderate-to-severe OSA who could not tolerate CPAP (AHI ≥ 20 events · h(-1); n = 68) showed an increased adjusted incidence of nonfatal CVE, especially new ischaemic strokes (hazard ratio 2.87, 95% CI 1.11-7.71; p = 0.03), compared with patients with moderate-to-severe OSA who tolerated CPAP (n = 28), patients with mild disease (AHI 10-19 events · h(-1); n = 36) and patients without OSA (AHI <10 events · h(-1); n = 31). Our results suggest that the presence of moderate-to-severe OSA is associated with an increased long-term incidence of nonfatal CVE in stroke patients and that CPAP reduces the excess of incidence seen in these patients.

[Impact of exacerbations on the clinical course of chronic obstructive pulmonary disease]. / Impacto de las exacerbaciones en la evolución de la EPOC.

The clinical course of chronic obstructive pulmonary disease (COPD) is marked by frequent exacerbations. Not all patients suffer exacerbations and not all decompensations have the same consequences; however, in the last few years, these episodes of clinical instability - especially if recurrent - have come to be viewed as a major element in the natural history of the disease insofar as they generate heavy workload and high costs, síntonegatively affect patients' quality of life, contribute to the multidimensional progression of the disease and, finally, affect its prognosis. The present article reviews the current scientific evidence on the impact of exacerbations on the clinical course of COPD and analyzes this impact from a multidimensional perspective. The need to base the management of COPD on clinical phenotypes is discussed, emphasizing the importance of the exacerbation phenotype, a clinical phenotype characterized by frequent exacerbations. This phenotype is often associated with the presence of cough and chronic expectoration, latent bronchial infection and bronchiectasis and leads to higher morbidity and mortality.

Impacto de las exacerbaciones en la evolución de la EPOC / Impact of exacerbations on the clinical course of chronic obstructive pulmonary disease

El curso clínico de la enfermedad pulmonar obstructiva crónica (EPOC) se ve salpicado con frecuencia por la presencia de exacerbaciones. Aunque no todos los pacientes sufren exacerbaciones y no todas estas descompensaciones tienen las mismas consecuencias, lo cierto es que en los últimos años hemos pasado a considerar estos episodios de inestabilidad clínica, especialmente si son repetidos, como elementos destacados en la historia natural de la enfermedad por cuanto generan una gran carga asistencial y enormes costes, impactan de forma negativa sobre la calidad de vida de los pacientes, contribuyen de forma decidida a la progresión multidimensional de la enfermedad y, finalmente, condicionan su pronóstico. El artículo revisa la evidencia científica actual acerca del impacto de la exacerbación sobre la evolución de la EPOC, analizando esta repercusión desde una perspect iva multidimensional. Además, introduce la necesidad de orientar el manejo de la EPOC hacia los fenotipos clínicos, destacando especialmente la importancia del fenotipo agudizador, un fenotipo clínico que se caracteriza por presentar repetidos episodios de agudización, que se asocia con frecuencia a la presencia de tos y expectoración crónica, infección bronquial latente y bronquiectasias, y que se caracteriza por presentar mayor morbimortalidad (AU)

The clinical course of chronic obstructive pulmonary disease (COPD) is marked by frequent exacerbations. Not all patients suffer exacerbations and not all decompensations have the same consequences; however, in the last few years, these episodes of clinical instability – especially if recurrent – have come to be viewed as a major element in the natural history of the disease insofar as they generate heavy workload and high costs síntonegatively affect pat ients’ quality of life, contribute to the multidimensional progression of the disease and, finally, affect its prognosis. The present article reviews the current scientific evidence on the impact of exacerbations on the clinical course of COPD and analyzes this impact from a multidimensional perspective. The need to base the management of COPD on clinical phenotypes is discussed, emphasizing the importance of the exacerbat ion phenotype, a clinical phenotype characterized by frequent exacerbations. This phenotype is often associated with the presence of cough and chronic expectorat ion, latent bronchial infect ion and bronchiectasis and leads to higher morbidity and mortality (AU)