Adaptación y validación al español del cuestionario de calidad de vida OSA-18 para la evaluación del síndrome de apnea-hipopnea de sueño infantil / Adaptation and Validation of the Spanish Version of OSA-18, a Quality of Life Questionnaire for Evaluation of Children with Sleep Apnea-Hypopnea Syndrome

Objetivos: Adaptar al español y analizar la fiabilidad y la validez de la versión española del cuestionario OSA-18 de calidad de vida (CVRS) en el síndrome de apnea-hipopnea del sueño (SAHS) infantil. Método: Se incluyeron niños con sospecha de SAHS a los que se practicó polisomnografía (PSG) pre y post adenoamigdalectomía (AA). Se analizó: edad, género, clínica, PSG, datos antropométricos, grados de Brodsky y Mallampati. Se administró OSA-18 basal y entre 3-6meses post AA. Tras la traducción-retrotraducción por personas bilingües se evaluaron la consistencia interna, la fiabilidad, la validez de constructo, la validez concurrente, la validez predictiva y la sensibilidad a los cambios. Resultados: Se evaluaron 45 niños y 15 niñas: IMC18 ± 4, cuello 28 ± 5, Brodsky (0: 7%; < 25%: 12%; 25-50%: 27%; > 50 a < 75%: 45%; > 75%: 6%), IAH: 12 ± 7 pre AA. El alfa de Cronbach del global fue 0,91. Las correlaciones entre dominios fueron significativas salvo para aspectos emocionales, aunque el global se correlacionó con todos los dominios (0,50-0,90). El análisis factorial mostró una estructura prácticamente idéntica al original. En la validez concurrente, el global mostró buena correlación (0,2-0,45). En su validez predictiva, diferenció adecuadamente los niveles de gravedad según Mallampati (ANOVA p = 0,002) e índice apnea-hipopnea (ANOVA p = 0,006). La sensibilidad al cambio fue excelente, tanto en el global (p < 0,001) como en cada dominio (p < 0,001), así como la fiabilidad test-retest. Conclusiones: La adaptación española del OSA-18 es comprensible y sus características psicométricas sugieren que la versión española es equivalente a la original y puede ser empleada en países de habla hispana

Objectives: To analyze the reliability and validity of the Spanish version of the OSA-18 quality of life questionnaire in children with apnea-hypopnea syndrome (SAHS). Method: Children with suspected SAHS were studied with polysomnography (PSG) before and after adenotonsillectomy (AA). Age, gender, clinical data, PSG, anthropometric data, and Mallampati and Brodsky scales were analyzed. OSA-18 was administered at baseline and 3-6months post AA. After translation and backtranslation by bilingual professionals, the internal consistency, reliability, construct validity, concurrent validity, predictive validity and sensitivity to change of the questionnaire was assessed. Results: In total, 45 boys and 15 girls were evaluated, showing BMI 18 ± 4, neck 28 ± 5, Brodsky (0: 7%; < 25%: 12%; 25-50%: 27%; > 50 to < 75%: 45%; > 75%: 6%), AHI 12 ± 7 pre AA. Global Cronbach alpha was 0.91. Correlations between domains were significant except for emotional aspects, although the total scores correlated with all domains (0.50 to 0.90). The factorial analysis was virtually identical to the original structure. The total scores showed good correlation for concurrent validity (0.2-0.45). With regard to predictive validity, the questionnaire adequately differentiated levels of severity according to Mallampati (ANOVA P = .002) and apnea-hypopnea index (ANOVA P = .006). Test-retest reliability was excellent, as was sensitivity to change, both in the total scores (P < .001) and in each domain (P < .001). Conclusions: The Spanish adaptation of the OSA-18 and its psychometric characteristics suggest that the Spanish version is equivalent to the original and can be used in Spanish-speaking countries

Adaptation and Validation of the Spanish Version of OSA-18, a Quality of Life Questionnaire for Evaluation of Children with Sleep Apnea-Hypopnea Syndrome. / Adaptación y validación al español del cuestionario de calidad de vida OSA-18 para la evaluación del síndrome de apnea-hipopnea de sueño infantil.

OBJECTIVES: To analyze the reliability and validity of the Spanish version of the OSA-18 quality of life questionnaire in children with apnea-hypopnea syndrome (SAHS). METHOD: Children with suspected SAHS were studied with polysomnography (PSG) before and after adenotonsillectomy (AA). Age, gender, clinical data, PSG, anthropometric data, and Mallampati and Brodsky scales were analyzed. OSA-18 was administered at baseline and 3-6months post AA. After translation and backtranslation by bilingual professionals, the internal consistency, reliability, construct validity, concurrent validity, predictive validity and sensitivity to change of the questionnaire was assessed. RESULTS: In total, 45 boys and 15 girls were evaluated, showing BMI 18±4, neck 28±5, Brodsky (0: 7%; <25%: 12%; 25-50%: 27%; >50 to <75%: 45%; >75%: 6%), AHI 12±7 pre AA. Global Cronbach alpha was 0.91. Correlations between domains were significant except for emotional aspects, although the total scores correlated with all domains (0.50 to 0.90). The factorial analysis was virtually identical to the original structure. The total scores showed good correlation for concurrent validity (0.2-0.45). With regard to predictive validity, the questionnaire adequately differentiated levels of severity according to Mallampati (ANOVA P=.002) and apnea-hypopnea index (ANOVA P=.006). Test-retest reliability was excellent, as was sensitivity to change, both in the total scores (P<.001) and in each domain (P<.001). CONCLUSIONS: The Spanish adaptation of the OSA-18 and its psychometric characteristics suggest that the Spanish version is equivalent to the original and can be used in Spanish-speaking countries.

Comparison of Costs and Clinical Outcomes Between Hospital and Outpatient Administration of Omalizumab in Patients With Severe Uncontrolled Asthma.

OBJECTIVES: To compare clinical outcomes and costs between two administration strategies of omalizumab treatment. METHOD: We evaluated two cohorts of patients with uncontrolled severe asthma over a 1-year period. Patients received the treatment in the primary care center in Hospital A and conventional hospital administration in Hospital B. RESULTS: We studied 130 patients, 86 in Hospital A and 44 in Hospital B, 30 men (24%) and 100 women (76%), age 50 ± 15 years, FEV1% 67 ± 22%, body mass index (BMI) 28 ± 6 kg/m(2), 639 ± 747 UI IgE/mL, followed for 24 ± 11 months (12-45), Asthma Control Test (ACT) score 12 ± 4 and Asthma Control Questionnaire (ACQ) 3 ± 2. There were no significant pretreatment differences between the groups in hospital admissions and emergency room visits in the previous year, nor in proportion of patients receiving oral steroids. Evaluations were performed at baseline and after 12 months of treatment, revealing significant differences in ACT (P<0.001), ACQ (P<0.001), improvement in FEV1% (P<0.001), reduction in total admissions (P<0.001), days of hospitalization (P<0.001), emergency room visits (P<0.001), cycles and doses of oral steroids (P<0.001) compared to the previous year. Hospitalization costs, emergency room visits, unscheduled visits to primary care and to the pulmonologist were significantly reduced in each hospital and on the whole, but administration and travel costs were 35% lower in the ambulatory strategy adopted in Hospital A. CONCLUSION: The administration of omalizumab in ambulatory health centers achieved the same clinical results as a hospital administration strategy, but with lower costs.

Consistencia interna y validez de la versión española del cuestionario de calidad de vida específico para el síndrome de apneas-hipopneas del sueño Quebec Sleep Questionnaire / Internal Consistency and Validity of the Spanish Version of the "Quebec Sleep Questionnaire" Quality-of-Life Questionnaire for Obstructive Sleep Apnea

Introducción: No existe ningún cuestionario específico de calidad de vida validado en castellano para su uso en pacientes con síndrome de apneas-hipopneas durante el sueño (SAHS). El objetivo del presente estudio fue validar la versión castellana del Quebec Sleep Questionnaire (QSQ). Material y métodos: Estudio multicéntrico en un grupo de pacientes diagnosticados de SAHS (IAH≥5) enviados a las Unidades de Sueño. En todos los pacientes se administraron los cuestionarios: SF-36, FOSQ, QSQ y test de Epworth. Se evaluaron las propiedades psicométricas (consistencia interna, validez de constructo, validez concurrente, validez predictora, fiabilidad test-retest y sensibilidad al cambio) del cuestionario QSQ (32 ítems en cinco dominios: somnolencia diurna, síntomas diurnos, síntomas nocturnos, emociones e interacciones sociales). Resultados: Se incluyeron 121 pacientes (edad media: 57±13 años; Epworth: 9±4; IMC 28±3kg·m−2 e IAH 36±20h−1). El análisis factorial mostró un constructo de cinco factores, distribuidos de manera similar a los dominios del cuestionario original. Tanto la consistencia interna (alfa de Cronbach entre 0,78 y 0,93 para los distintos dominios), la validez concurrente con respecto al SF-36, Epworth y FOSQ, la validez predictora de gravedad del SAHS, como la fiabilidad test-retest fueron adecuadas. El QSQ mostró una buena sensibilidad al cambio en los dominios relativos a los síntomas diurnos (p=0,003) y nocturnos (p=0,02). Conclusiones: La versión española del QSQ presenta unas características psicométricas adecuadas para su utilización en pacientes con SAHS, así como una sensibilidad al cambio significativa en los dominios de síntomas(AU)

Introduction: There is no specific health-related quality of life (HRQL) questionnaire that has been validated in Spanish for its use in patients with sleep apnea-hypopnea syndrome (SAHS). The objective of the present study was to validate the Spanish version of the Quebec Sleep Questionnaire (QSQ). Patients and methods: A multi-center study including a group of patients with SAHS (AHI≥5) referred to the Sleep Unit. All patients completed the following questionnaires: SF-36, FOSQ, QSQ and Epworth scale. Internal consistency, construct validity, concurrent validity, predictive validity, repeatability and responsiveness to change of the QSQ (32 items in five domains: daytime sleepiness, diurnal symptoms, nocturnal symptoms, emotions, and social interactions) were assessed. Results: A hundred twenty one patients were included in the study (mean age: 57±13; mean Epworth: 9±4; mean Body Mass Index (BMI): 28±3kg·m−2 and mean AHI: 36±20hour−1). The factorial analysis showed a construct of five factors with similar distribution to the original questionnaire domains. Internal consistency (Cranach's alpha between 0.78 and 0.93 for the different domains), concurrent validity (compared to SF-36, Epworth scale and FOSQ), predictive validity of SAHS severity and test-retest reliability were appropriate. The test showed good responsiveness to change in diurnal (P=.003) and nocturnal symptoms domains (P=.02). Conclusions: The Spanish version of the QSQ is a valid HRQL measure with appropriate psychometric properties for use in patients with SAHS and is responsive to change in symptoms domains(AU)

Internal consistency and validity of the Spanish version of the "Quebec Sleep Questionnaire" quality-of-life questionnaire for obstructive sleep apnea.

INTRODUCTION: There is no specific health-related quality of life (HRQL) questionnaire that has been validated in Spanish for its use in patients with sleep apnea-hypopnea syndrome (SAHS). The objective of the present study was to validate the Spanish version of the Quebec Sleep Questionnaire (QSQ). PATIENTS AND METHODS: A multi-center study including a group of patients with SAHS (AHI≥5) referred to the Sleep Unit. All patients completed the following questionnaires: SF-36, FOSQ, QSQ and Epworth scale. Internal consistency, construct validity, concurrent validity, predictive validity, repeatability and responsiveness to change of the QSQ (32 items in five domains: daytime sleepiness, diurnal symptoms, nocturnal symptoms, emotions, and social interactions) were assessed. RESULTS: A hundred twenty one patients were included in the study (mean age: 57 ± 13; mean Epworth: 9 ± 4; mean Body Mass Index (BMI): 28 ± 3 kg·m(-2) and mean AHI: 36 ± 20 hour(-1)). The factorial analysis showed a construct of five factors with similar distribution to the original questionnaire domains. Internal consistency (Cranach's alpha between 0.78 and 0.93 for the different domains), concurrent validity (compared to SF-36, Epworth scale and FOSQ), predictive validity of SAHS severity and test-retest reliability were appropriate. The test showed good responsiveness to change in diurnal (P=.003) and nocturnal symptoms domains (P=.02). CONCLUSIONS: The Spanish version of the QSQ is a valid HRQL measure with appropriate psychometric properties for use in patients with SAHS and is responsive to change in symptoms domains.

Ventilación no invasiva / Non-invasive ventilation

La llegada de la ventilación mecánica no invasiva (VMNI) ha condicionado un cambio radical en el manejode la insuficiencia respiratoria aguda y crónica. A lo largo de los últimos años, hemos asistido al incrementoprogresivo en el número de aplicaciones posibles de la VMNI, tanto en el ámbito hospitalario como extrahospitalario.Su uso se ha universalizado en todos los hospitales y en la actualidad los residentes del sigloXXI reciben una formación específica que no existía hasa hace sólo unos años.Es deber de todos nosotros encabezar el avance asistencial y científico que ha supuesto el desarrollo de laVMNI, liderando los acontecimientos que acompañen al mejor conocimiento de las bases fisiopatológicasde la ventilación, de sus continuas aplicaciones en la práctica clínica diaria y del perfeccionamiento de loselementos necesarios para una correcta aplicación de la técnica.En la presente revisión se pretende efectuar un recorrido global en el procedimiento de la VMNI, desde losconocimientos más teóricos –fisiopatología de la VMNI–, hasta las habilidades más prácticas –reconocimientode las asincronías paciente-ventilador–. En este progreso de lo complejo a lo básico o de lo básico alo complejo, según se mire, intentaremos profundizar en las nociones necesarias para comprender el propiofuncionamiento técnico del ventilador, adentrándonos en los diferentes modos y parámetros, y exponiendolas capacidades que debemos desarrollar para la correcta indicación, uso y monitorización de latécnica, con una última reflexión acerca de otras ayudas respiratorias que podemos ofrecer a pacientes confracaso ventilatorio(AU)

The advent of non-invasive mechanical ventilation (NIMV) has radically changed the management of acuteand chronic respiratory failure. Over the last few years, the number of possible applications of NIMV hasprogressively increased, both in the hospital and extrahospital setting. NIMV is now used in all hospitals andresident physicians currently receive specific training –nonexistent until a few years ago– in this modality.It falls to all of us to push forward the clinical and scientific advances represented by the development ofNIMV, by promoting the events that accompany better knowledge of the physiopathological bases ofventilation and of its continuous applications in daily clinical practice and by perfecting the elementsrequired for the correct application of this technique.The present review aims to provide a broad overview of NIMV, from the most theoretical knowledge (thephysiopathology of NIMV) to the most practical skills (recognition of patient-ventilator asynchrony).Through this progression from the complex to the most basic, or from the basics to the most complex,depending on the perspective taken, we aim to provide deeper knowledge of the concepts required tounderstand the technical functioning of the ventilator, describing its distinct modes and parameters andthe abilities that must be developed for the correct indication, use and monitoring of the technique. Weprovide a final reflection on other forms of respiratory support that can be offered to patients withventilatory failure(AU)

Sleep-related painful erection in a 50-year-old man successfully treated with cinitapride.

INTRODUCTION: The sleep-related painful erection (SRPE) is a well-established parasomnia characterized by episodes of penile pain during an erection and typically appears during REM sleep. It is associated with nocturnal awakenings, anxiety, and irritability. AIM: To report a case study that highlights the successful treatment of SRPE with cinitapride. METHODS: We present a case report of a 50-year-old man suffering from SRPE that was studied by polysomnography. RESULTS: Severe fragmentation of rapid eye movement (REM) sleep was observed, and nine episodes of sleep-related erections were observed through the night; they were associated with REM sleep, and five of them were classified as SRPE. Cinitapride before the onset of sleep was started. Both the frequency and intensity of SRPE gradually decreased during a period of 6 months with the maintenance of normal sexual function. CONCLUSION: Cinitapride can play a role in reducing SRPE at night probably due to central modulation of neurotransmitters mediating erection.

[Non-invasive ventilation]. / Ventilación no invasiva.

The advent of non-invasive mechanical ventilation (NIMV) has radically changed the management of acute and chronic respiratory failure. Over the last few years, the number of possible applications of NIMV has progressively increased, both in the hospital and extrahospital setting. NIMV is now used in all hospitals and resident physicians currently receive specific training -nonexistent until a few years ago- in this modality. It falls to all of us to push forward the clinical and scientific advances represented by the development of NIMV, by promoting the events that accompany better knowledge of the physiopathological bases of ventilation and of its continuous applications in daily clinical practice and by perfecting the elements required for the correct application of this technique. The present review aims to provide a broad overview of NIMV, from the most theoretical knowledge (the physiopathology of NIMV) to the most practical skills (recognition of patient-ventilator asynchrony). Through this progression from the complex to the most basic, or from the basics to the most complex, depending on the perspective taken, we aim to provide deeper knowledge of the concepts required to understand the technical functioning of the ventilator, describing its distinct modes and parameters and the abilities that must be developed for the correct indication, use and monitoring of the technique. We provide a final reflection on other forms of respiratory support that can be offered to patients with ventilatory failure.