Polysomnographic Characteristics of Snoring Children: A Familial Study of Obstructive Sleep Apnea Syndrome / Características polisomnográficas de los niños que roncan: un estudio familiar del síndrome de apnea obstructiva del sueño

Background and objectives: Available evidence suggests a familial basis for OSA. The aim of the present study was to assess the potential influences of parental OSA in predicting the diagnosis and severity of OSA in snoring children.Methods: Observational study, we prospectively enrolled 84 children and their parents. A complete nocturnal polysomnography was performed. Children were categorized into 3 severity groups according to the apnea–hypopnea index (AHI<1h−1, AHI≥1h−1 to AHI<5h−1, and AHI≥5h−1). Adults were grouped according two criteria (AHI≥5h−1 and ≥10h−1).Results: There were no significant differences in age, gender, BMI and BMI z-score among groups. Among the children, 54.7% had an AHI≥1h−1 and 21.4% had an AHI≥5h−1. Overall, we observed that 60.7% of fathers and 23.8% of mothers of our population had OSA (AHI≥5h−1). The prevalence of fathers with OSA increases with the children's severity (83% in the group of children with moderate-severe OSA, p=0.035). The odds of having moderate-severe pediatric OSA (AHI≥5h−1) were more than 4 times higher among children with a father with AHI≥5h−1 (OR: 4.92, 95% CI: 1.27–19.06; p=0.021). There was no evidence of any maternal influence on OSA severity among the children studied.Conclusions: Our findings suggest a high prevalence of OSA among the family members studied with an increased association of childhood OSA with paternal OSA. Prediction of OSA risk among children can be significantly improved by adding data on paternal OSA status. (AU)

Contexto y objetivos: La evidencia disponible sugiere una base familiar para la AOS. El objetivo del presente estudio fue evaluar las posibles influencias de la AOS de los padres para predecir el diagnóstico y la gravedad de la AOS en los niños que roncan.Métodos: Estudio observacional en el que incluimos prospectivamente a 84 niños y sus padres. Se realizó una polisomnografía nocturna completa. Los niños se clasificaron en 3 grupos de gravedad según el índice de apnea-hipopnea (IAH <1h−1, IAH ≥1h−1 a IAH <5h−1y IAH ≥5h−1). Los adultos se agruparon según dos criterios (IAH ≥5 h-1 y ≥10 h-1).Resultados: No había diferencias significativas en la edad, el sexo, el IMC y la puntuación z del IMC entre los grupos. Entre los niños, el 54,7% tenía un IAH ≥1h−1 y el 21,4% tenía un IAH ≥5h−1. En general, observamos que el 60,7% de los padres y el 23,8% de las madres de nuestra población tenían AOS (IAH ≥5h−1). La prevalencia de padres con AOS aumenta con la gravedad de la AOS en los niños (83% en el grupo de niños con AOS moderada-grave, p=0,035). La probabilidad de tener AOS pediátrica moderada-grave (IAH ≥5h−1) fue más de 4 veces mayor en los niños con un padre con IAH≥5h−1 (OR: 4,92, IC 95%: 1,27-19,06; p=0,021). No hubo evidencia de que hubiera alguna influencia materna en la gravedad de la AOS en los niños estudiados.Conclusiones: Nuestros hallazgos sugieren una alta prevalencia de AOS entre los miembros de la familia estudiados con una mayor asociación de la AOS infantil con la AOS paterna. La predicción del riesgo de AOS entre los niños puede mejorarse significativamente al incluir información sobre el estado de la AOS paterna. (AU)

Prothrombotic state in children with obstructive sleep apnea.

OBJECTIVE: Increased blood coagulation might be one important mechanism linking obstructive sleep apnea (OSA) with cardiovascular diseases. We tested the association between several hemostatic parameters and sleep breathing-related variables in a representative pediatric population with a clinical suspicion of OSA. METHODS: Polysomnography was performed in 152 snoring children to diagnose OSA. Anthropometric and clinical data were registered and venous blood samples were collected for the measurement of platelet count, plateletcrit, platelet distribution width (PDW), mean platelet volume (MPV), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and C-reactive protein. RESULTS: Children with OSA had significantly higher platelet count, plateletcrit and PDW compared with those without OSA. After controlling for the anthropometric characteristics (age, gender, body mass index (BMI) z-score), platelet count negatively correlated with minimum SaO2 while the plateletcrit correlated with time with SaO2 <90% and MPV correlated with apnea-hypopnea index. PT and PT international normalized ratio correlated with mean SaO2 and aPTT correlated with the oxygen desaturation index. CONCLUSION: Our findings suggest that different OSA-related effects may be factors contributing to an enhanced coagulability in pediatric OSA. Measures reflecting apnea severity and disrupted sleep were associated with clotting factor changes independent of covariates affecting hemostatic function.

Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort.

RATIONALE: Obstructive sleep apnea (OSA) has been associated with increased cancer mortality, but whether it is also associated with cancer incidence is unknown. OBJECTIVES: To investigate whether OSA is associated with increased cancer incidence in a large clinical cohort. METHODS: A multicenter, clinical cohort study including consecutive patients investigated for suspected OSA between 2003 and 2007 in seven Spanish teaching hospitals. Apnea-hypopnea index (AHI) and percent nighttime with oxygen saturation less than 90% (TSat(90)) were used as surrogates of OSA severity, both as continuous variables and categorized by tertiles. Cox proportional hazards regression analyses were used to calculate hazard ratio (HR) and 95% confidence interval (CI) for cancer incidence after adjusting for confounding variables. MEASUREMENTS AND MAIN RESULTS: A total of 4,910 patients were analyzed (median follow-up, 4.5 yr; interquartile range, 3.4-5.2). Compared with the lower TSat(90) category (<1.2%), the adjusted hazards (95% CI) of cancer incidence for increasing categories were 1.58 (1.07-2.34) for TSat(90) 1.2-12% and 2.33 (1.57-3.46) for TSat(90) greater than 12%. Continuous TSat(90) was also associated with cancer incidence (adjusted HR, 1.07 [1.02-1.13] per 10-unit increase in TSat(90)). In stratified analyses, TSat(90) was associated with cancer incidence in patients younger than 65 years (adjusted HR, 1.13 [95% CI, 1.06-1.21] per 10-unit increase in TSat(90)) and males (adjusted HR, 1.11 [95% CI, 1.04-1.17] per 10-unit increase in TSat(90)). AHI was not associated with cancer incidence in the adjusted analyses, except for patients younger than 65 years (adjusted HR for AHI >43 vs. <18.7, 1.66; 95% CI, 1.04-2.64). CONCLUSIONS: Increased overnight hypoxia as a surrogate of OSA severity was associated with increased cancer incidence. This association seems to be limited to men and patients younger than 65 years of age.

TRAMOMTANA (Tratamiento Multidisciplinar de la Obesidad Mórbida: Medicamentos, Terapia de comportamiento, Apoyo Nutricional y Actividad física). De la pregunta a la realidad de un ensayo clínico investigador iniciado (II) / TRAMOMTANA (Multidisciplinary treatment of morbid obesity: Medication, behavioral therapy, nutritional support, and physical activity). From question to reality in an investigator-initiated clinical trial (II)

Comunicamos la puesta en marcha de un programa intensivo y multidisciplinar de pérdida de peso en pacientes con obesidad mórbida (OM). Este ensayo clínico se basa en la educación para la salud, el apoyo en el proceso de cambio, los medicamentos y las sesiones de terapia de grupo. Nuestra intención es demostrar que los resultados obtenidos con este programa de pérdida de peso a 2 años son, cuando menos, comparables a los resultados que se obtienen con la cirugía bariátrica en estos pacientes con OM. Es nuestra intención igualmente (..) (AU)

Implementation of an intensive, multidisciplinary weight loss program in patients with morbid obesity is reported. This program is based on behavioral changes, lifestyle intervention, medication, and group therapy sessions. Our objective is to show that the results achieved with this two-year weight loss program will be at least similar to those achieved with bariatric surgery in patients with morbid obesity. We also intend to show that this multidisciplinary treatment induces an improvement in the comorbidity rate associated to smaller costs for our national health system (AU)

Influencia del sexo en las variables clínicas y polisomnográficas del síndrome de apneas del sueño / Differences in clinical and polysomnographic variables between male and female patients with sleep apnea-hypopnea syndrome

OBJETIVO: Comparar, en una cohorte amplia de pacientescon síndrome de apneas-hipopneas durante el sueño, las característicasclínicas, antropométricas y polisomnográficas enfunción del sexo.PACIENTES Y MÉTODOS: En el estudio, realizado en 6 hospitalesuniversitarios españoles, se incluyó a pacientes consecutivoscon un índice de apneas-hipopneas del sueño mayorde 5 h–1, que fueron evaluados entre 2003 y 2005. Se dividieronen función del sexo y, posteriormente, en función de laedad: pacientes jóvenes (≤ 45 años) y adultos (> 45 años).RESULTADOS: Se ha estudiado a 2.464 varones y 424 mujeres.Las mujeres eran mayores (edad media ± desviación estándar:56 ± 12 frente a 51 ± 12 años; p < 0,0001), pesabanmás (índice de masa corporal: 31 ± 6 frente a 30 ± 5 kg/m2;p < 0,0001) y presentaban una mayor circunferencia de cadera(119 ± 15 frente a 111 ± 12 cm; p < 0,0001) y una menorcircunferencia de cuello (38 ± 3 frente a 42 ± 9 cm;p < 0,0001) que los varones. El grado de somnolencia diurna(escala de Epworth) y el índice de apneas-hipopneas eran similaresen ambos grupos, aunque el de mujeres presentabauna latencia de sueño más larga (23 ± 28 frente a 27 ± 32min; p < 0,004) y una saturación de oxígeno media (un 92 ±4 frente a un 91 ± 5%) y mínima menor (un 78 ± 11 frente aun 75 ± 12%; p < 0,0001) que los varones. Al diferenciar losgrupos por edad, en el grupo de jóvenes sólo se manteníanlas diferencias ponderales, mientras que entre los adultos reaparecíanlas diferencias en los valores de saturación nocturna.CONCLUSIONES: Las mujeres con síndrome de apneas-hipopneasdurante el sueño son más obesas que los varones yconsultan a una edad más avanzada. Desde el punto de vistaclínico y polisomnográfico, no hay grandes diferencias enfunción del sexo. Únicamente la latencia de sueño es superiory la hipoxemia nocturna más acentuada

OBJECTIVE: The aim of this study was to compare theclinical, anthropometric, and polysomnographic characteristicsof a broad group of patients with sleep apnea-hypopneasyndrome according to sex.PATIENTS AND METHODS: The study, conducted in 6 Spanishuniversity hospitals, included consecutive patients attendedfrom 2003 through 2005 with an apnea-hypopnea indexgreater than 5. Groups were formed according to sex andthen stratified into age subgroups of younger (≤45 years) andolder patients (> 45 years) for further comparison.RESULTS: The study included 2464 men and 424 women.Women were older (mean [SD] age, 56 [12] years vs51 [12] years), weighed more (body mass index, 31 [6] kg/m2 vs30 [5] kg/m2), and had a larger hip circumference (119 [15] cmvs 111 [12] cm) and smaller neck circumference (38 [3] cmvs 42 [9] cm) than men (P<.001 in all cases). The degree ofdaytime sleepiness (Epworth scale) and the apnea-hypopneaindex were similar in both groups, although women had alonger sleep latency (23 [28] minutes vs 27 [32] minutes;P<.004) and a higher mean oxygen saturation (92% [4%] vs91% [5%]) and minimum oxygen saturation (78% [11%] vs75% [12%]; P<.0001) than men. On stratification by age,only weight differences between men and women wereobserved in the younger group whereas the older group alsoshowed differences in oxygen saturation during sleep.CONCLUSIONS: Women with sleep apnea-hypopnea aremore overweight than men and tend to seek medicalattention at an older age. The clinical and polysomnographicvariables were generally similar for men and women—theonly differences were that sleep latency was longer andhypoxemia during sleep was more accentuated in women

Impacto de la presencia de un neumólogo de guardia sobre la actividad de un servicio de neumología / Impact of an on-duty pulmonologist on the activity of a respiratory medicine department

OBJETIVO: Analizar qué impacto asistencial y de gestión clínica tiene la implantación de guardias de presencia física continuada en un servicio de neumología. MÉTODOS: En febrero de 2004 se introdujeron las guardias de neumología en el Hospital Universitario Son Dureta. Durante un año, hasta enero de 2005, se recogió de forma prospectiva y sistemática la actividad realizada por el/la neumólogo/a de guardia. Con objeto de situar estos resultados en perspectiva, se ha comparado el número de ingresos mensuales y su estancia media durante los 12 meses en que se ha dispuesto de guardia de neumología y los 12 meses inmediatamente anteriores. RESULTADOS: Durante los 12 meses evaluados, el/la neumólogo/a de guardia recibió una media ± desviación estándar de 9,02 ± 5,27 avisos urgentes cada día, realizó 202 técnicas diagnósticas/terapéuticas y dio de alta a 342 pacientes. Durante este período ingresaron en el servicio 1.305 pacientes (estancia media: 8,1 días), mientras que en los 12 meses previos, sin guardia de la especialidad, habían ingresado en el servicio 1.680 pacientes (estancia media: 9,0 días); esto supone una reducción del 22,3% del número anual de ingresos y una disminución de la estancia media de los pacientes ingresados de prácticamente un día (0,9 días). CONCLUSIONES: La implantación de guardias de neumología ha sido una medida eficiente, que ha contribuido a agilizar la rotación de los pacientes ingresados

OBJECTIVE: To evaluate the impact on health care and clinical management of 24-hour coverage by an on-site pulmonologist in a respiratory medicine department. METHODS: In February 2004, a new respiratory medicine 24-hour duty service was started in our hospital. The activity of the on-duty pulmonologist during the following 12 months was systematically and prospectively recorded. The results were put into perspective by comparing the number of monthly admissions and the mean length of stay during the study period with those of the previous 12-month period. RESULTS: During the study period, the on-duty pulmonologist received a mean (SD) of 9.02 (5.27) emergency calls every day, performed 202 diagnostic or therapeutic interventions, and discharged 342 patients. During this period, 1305 patients were admitted to the department (mean length of stay, 8.1 days), whereas in the previous 12 months, with no on-site pulmonologist, 1680 patients were admitted (mean length of stay, 9.0 days). This represents a 22.3% reduction in the annual number of admissions and a reduction in the mean stay by almost 1 day (0.9 days). CONCLUSIONS: The provision of an on-duty pulmonologist was efficient because it facilitated patient turnaround

Daytime sleepiness and polysomnography in obstructive sleep apnea patients.

BACKGROUND: Excessive daytime sleepiness (EDS) is the major complaint in subjects with obstructive sleep apnea syndrome (OSAS). However, EDS is not universally present in all patients with OSAS. The mechanisms explaining why some patients with OSAS complain of EDS whereas others do not are unknown. OBJECTIVE: To investigate polysomnographic determinants of excessive daytime sleepiness (EDS) in a large multicenter cohort of patients with obstructive sleep apnea (OSAS). METHODS: All consecutive patients with an apnea-hypopnea index greater than 5h(-1) who were evaluated between 2003 and 2005. EDS was assessed using the Epworth Sleepiness Scale (ESS), and patients were considered to have EDS if the ESS was >10. RESULTS: A total of 1649 patients with EDS ((mean [+/-SD] Epworth 15+/-3) and 1233 without EDS (Epworth 7+/-3) were studied. Patients with EDS were slightly younger than patients without EDS (51+/-12 vs 54+/-13 years, p<0.0001), had longer total sleep time (p<0.007), shorter sleep latency (p<0001), greater sleep efficiency (p<0.0001) and less NREM sleep in stages 1 and 2 (p<0.007) than those without EDS. Furthermore, patients with EDS had slightly higher AHI (p<0.005) and arousal index (p<0.001) and lower nadir oxygen saturation (p<0.01). CONCLUSIONS: Patients with OSAS and EDS are characterized by longer sleep duration and increased slow wave sleep compared to those without EDS. Although patients with EDS showed a mild worsening of respiratory disturbance and sleep fragmentation, these results suggest that sleep apnea and sleep disruption are not the primary determinants of EDS in all of these patients.