Valor diagnóstico de la poligrafía respiratoria en pacientes con baja probabilidad de síndrome de apneas e hipopneas durante el sueño / Diagnostic value of respiratory polygraphy in patients with low probability of obstructive sleep apnea syndrome

Introducción y objetivo: La polisomnografía (PSG) es el método estándar para el diagnóstico del síndrome de apneas e hipopneas del sueño (SAHS). Es una técnica cara, compleja y de poca disponibilidad, por lo que la poligrafía respiratoria (PR) es de uso habitual. La PR no está validada en casos de baja probabilidad; sin embargo, la normativa vigente contempla el tratamiento conservador en caso de PR negativa. Nos hemos propuesto estudiar la prevalencia y gravedad del SAHS mediante PSG, en una muestra de pacientes con baja probabilidad y PR negativa. Material y métodos: Estudio retrospectivo, observacional, descriptivo y analítico de pacientes con baja probabilidad de SAHS y PR negativa a los que se les realizó posteriormente una PSG. Se registraron datos antropométricos, clínicos y características del sueño. Resultados: Ochenta y dos pacientes fueron incluidos. En el registro de la PSG se observó un incremento de hipopneas (137,8 ± 70,1 frente a 51,2 ± 38,4 [p < 0,05]) y del índice de apneas e hipopneas (27,8 ± 15,6 frente a 11,7 ± 7,1 [p < 0,05]), así como un aumento del 17% en la prevalencia de SAHS, de un 35% de casos graves y una disminución de un 41% de los casos leves. Conclusión: De acuerdo con los resultados de este estudio, la PR subestima de forma estadísticamente significativa la prevalencia y gravedad del SAHS en pacientes con baja probabilidad. Es necesario un adecuado proceso de estratificación de riesgo para la correcta indicación de pruebas diagnósticas, y recomendable realizar una PSG cuando se ha realizado una PR con resultado negativo en estos pacientes (AU)

Introduction and objective: Polysomnography (PSG) is the gold standard technic for the diagnosis of obstructive sleep apnea syndrome (OSAS). It is an expensive, complex and not always available technic, meaning that respiratory polygraphy (RP) has become usual. Although RP is not validated in low probability patients, Spanish guidelines recommend conservative treatment in patients with negative RP. We intended to study the prevalence and severity of OSAS through PSG in a sample of patients with low probability and negative RP. Material and methods:Retrospective, observational, descriptive and analytic study of low probability OSAS patients with negative RP in whom a PSG was performed. Anthropometric, clinical and sleep data were collected. Results: Eighty-two patients were included. After PSG, a greater number of hypopneas (137.8 ± 70.1 vs. 51.2 ± 38.4 [P < .05]) and apnea hypopnea index (27.8 ± 15.6 vs. 11.7 ± 7.1 [P < .05]) was observed, as well as an increment in OSAS prevalence of 17%, which was 35% in severe OSAS. In mild OSAS, there was a decrement of 41%. Conclusion: According with the results of this study, RP significantly underestimates the prevalence and severity of OSAS in low probability patients. While it is necessary to adequately stratify the OSAS probability in order to correctly indicate diagnosis tests, we recommend performing a PSG in low probability patients with negative RP (AU)

[Diagnostic value of respiratory polygraphy in patients with low probability of obstructive sleep apnea syndrome]. / Valor diagnóstico de la poligrafía respiratoria en pacientes con baja probabilidad de síndrome de apneas e hipopneas durante el sueño.

INTRODUCTION AND OBJECTIVE: Polysomnography (PSG) is the gold standard technic for the diagnosis of obstructive sleep apnea syndrome (OSAS). It is an expensive, complex and not always available technic, meaning that respiratory polygraphy (RP) has become usual. Although RP is not validated in low probability patients, Spanish guidelines recommend conservative treatment in patients with negative RP. We intended to study the prevalence and severity of OSAS through PSG in a sample of patients with low probability and negative RP. MATERIAL AND METHODS: Retrospective, observational, descriptive and analytic study of low probability OSAS patients with negative RP in whom a PSG was performed. Anthropometric, clinical and sleep data were collected. RESULTS: Eighty-two patients were included. After PSG, a greater number of hypopneas (137.8±70.1 vs. 51.2±38.4 [P<.05]) and apnea hypopnea index (27.8±15.6 vs. 11.7±7.1 [P<.05]) was observed, as well as an increment in OSAS prevalence of 17%, which was 35% in severe OSAS. In mild OSAS, there was a decrement of 41%. CONCLUSION: According with the results of this study, RP significantly underestimates the prevalence and severity of OSAS in low probability patients. While it is necessary to adequately stratify the OSAS probability in order to correctly indicate diagnosis tests, we recommend performing a PSG in low probability patients with negative RP.

[Bronchogenic carcinoma 2000-2001: characteristics and overall survival]. / Carcinoma broncogénico 2000-2001: características y supervivencia global.

OBJECTIVE: To describe the clinical characteristics and survival of patients diagnosed with bronchogenic carcinoma during the years 2000 and 2001 in a tertiary level hospital. PATIENTS AND METHODS: Data were collected from our hospital's tumor registry and validated with independent sources. Of all the patients diagnosed with or treated for bronchogenic carcinoma in our hospital, only those from our health care area were selected. RESULTS: During the 2-year study period, 482 patients were diagnosed. Of those, 91% were men. The mean (SD) age was 66.6 (9.65) years. Large cell carcinomas accounted for 29.4% of cases. Of all the cases of bronchogenic carcinoma, 41.3% were diagnosed in stage IV. Thirty percent of non-small cell carcinomas were classified as stage I, compared to 6% of small cell carcinomas (P< .001). The most frequent treatment was chemotherapy (42.1%) and 20% of patients underwent surgery. The overall 5-year survival rate was 13% (95% confidence interval [CI], 10%-16%), while survival was significantly lower in patients aged 68 years or older (95% CI, 3%-15%; P< .001) and in patients with small cell carcinoma (0%, P< .01). CONCLUSIONS: Our recent experience (2000-2001) confirmed the advanced age of patients with bronchogenic carcinoma, the frequency of diagnosis in advanced stages of the disease (41% in stage IV), and the low overall 5-year survival rate (13%).

Carcinoma broncogénico 2000-2001: características y supervivencia global / Bronchogenic carcinoma 2000-2001: characteristics and overall survival

Objetivo: Describir las características clínicas y la supervivencia de los carcinomas broncogénicos (CB) diagnosticados durante los años 2000 y 2001 en un hospital terciario. Pacientes y métodos: La información se recogió de la base de datos del Registro de Tumores del hospital y se validó con fuentes independientes. De todos los pacientes con CB diagnosticados o tratados en nuestro centro, se seleccionó a los que provenían exclusivamente del área de salud correspondiente. Resultados: Se diagnosticaron 482 casos en los 2 años del estudio; un 90% de los pacientes eran varones. La edad media ± desviación estándar fue de 66,6 ± 9,65 años. El 29,4% eran CB de células grandes. El 41,3% de todos los CB se diagnosticaron en estadio IV. El 30% de los CB no microcíticos se clasificaron en estadio I, en comparación con el 6% de los CB microcíticos (p < 0,001). El tratamiento más frecuente fue la quimioterapia (42,1%); la cirugía se efectuó en el 20% de los casos. La supervivencia global a los 5 años fue de 13% (intervalo de confianza del 95%, 10-16%), y fue significativamente inferior (p < 0,001) en los pacientes con mayor edad (≥ 68 años), en quienes se cifró en un 9% (intervalo de confianza del 95%, 3-15), y en el CB microcítico (0%; p < 0,01). Conclusiones: Se confirma en nuestra reciente experiencia (2000-2001) la elevada edad de los pacientes con CB, el frecuente diagnóstico en estadios avanzados (estadio IV: 41%) y la deficiente supervivencia global a los 5 años (el 13% del global)

Objective: To describe the clinical characteristics and survival of patients diagnosed with bronchogenic carcinoma during the years 2000 and 2001 in a tertiary level hospital. Patients and Methods: Data were collected from our hospital´s tumor registry and validated with independent sources. Of all the patients diagnosed with or treated for bronchogenic carcinoma in our hospital, only those from our health care area were selected. Results: During the 2-year study period, 482 patients were diagnosed. Of those, 91% were men. The mean (SD) age was 66.6 (9.65) years. Large cell carcinomas accounted for 29.4% of cases. Of all the cases of bronchogenic carcinoma, 41.3% were diagnosed in stage IV. Thirty percent of non-small cell carcinomas were classified as stage I, compared to 6% of small cell carcinomas (P<.001). The most frequent treatment was chemotherapy (42.1%) and 20% of patients underwent surgery. The overall 5-year survival rate was 13% (95% confidence interval [CI], 10%-16%), while survival was significantly lower in patients aged 68 years or older (95% CI, 3%-15%; P<.001) and in patients with small cell carcinoma (0%, P<.01). Conclusions: Our recent experience (2000-2001) confirmed the advanced age of patients with bronchogenic carcinoma, the frequency of diagnosis in advanced stages of the disease (41% in stage IV), and the low overall 5-year survival rate (13%)