Ambulatory circadian monitoring (ACM) based on thermometry, motor activity and body position (TAP): a comparison with polysomnography.

An integrated variable based on the combination of wrist Temperature, motor Activity and body Position (TAP) was previously developed at our laboratory to evaluate the functioning of the circadian system and sleep-wake rhythm under ambulatory conditions. However, the reliability of TAP needed to be validated with polysomnography (PSG). 22 subjects suffering from sleep disorders were monitored for one night with a temperature sensor (iButton), an actimeter (HOBO) and exploratory PSG. Mean waveforms, sensitivity (SE), specificity (SP), agreement rates (AR) and comparisons between TAP and sleep stages were studied. The TAP variable was optimized for SE, SP and AR with respect to each individual variable (SE: 92%; SP: 78%; AR: 86%). These results improved upon estimates previously published for actigraphy. Furthermore, TAP values tended to decrease as sleep depth increased, reaching the lowest point at phase 3. Finally, TAP estimates for sleep latency (SL: 37±9 min), total sleep time (TST: 367±13 min), sleep efficiency (SE: 86.8±1.9%) and number of awakenings (NA>5 min: 3.3±.4) were not significantly different from those obtained with PSG (SL: 29±4 min; SE: 89.9±1.8%; NA>5 min: 2.3±.4), despite the heterogeneity of the sleep pathologies monitored. The TAP variable is a novel measurement for evaluating circadian system status and sleep-wake rhythms with a level of reliability better to that of actigraphy. Furthermore, it allows the evaluation of a patient's sleep-wake rhythm in his/her normal home environment, and at a much lower cost than PSG. Future studies in specific pathologies would verify the relevance of TAP in those conditions.

Correlación entre la clínica y la polisomnografía en los trastornos respiratorios del sueño infantil / Clinical and polysomnographic correlation in sleep-related breathing disorders in children

Introducción: A pesar de que la polisomnografía supone la prueba diagnóstica por excelencia de los trastornos respiratorios del sueño en niños, existe controversia sobre su indicación en todos los casos. De entre los argumentos utilizados, tanto a favor como en contra, se encuentra la falta de correlación existente entre sus valores objetivos y la sintomatología. Objetivo: Evaluar la correlación entre los datos clínicos y el índice de apnea-hipoapnea (IAH), en nuestro entorno de trabajo. Material y método: Se compara estadísticamente la clínica preoperatoria y el IAH de 170 niños con trastorno respiratorio del sueño, sometidos a polisomnografia. También se evalúa la correlación a nivel postoperatorio, con un subgrupo de 80 niños intervenidos de adenoamigdalectomía con seguimiento polisomnográfico a un año. Resultados: A nivel preoperatorio únicamente el grado de hipertrofia amigdalar mostró correlación significativa con el IAH. A nivel postoperatorio se evidencia una correlación entre el IAH y las apneas observadas: 38,1% de los niños mejoran según los padres en el grupo con persistencia polisomnográfica y el 66,7% en el grupo con resolución de la enfermedad (p=0,023). También muestra correlación el nivel de mejora del ronquido, valorado mediante escala analógica visual. La media bajó 5 puntos en el grupo persistente y 6,1 en el grupo con resolución de la enfermedad (p=0,047). Conclusión: A pesar de las limitaciones en la correlación entre la clínica y la polisomnografia, especialmente en el preoperatorio, la prueba objetiva por excelencia sigue siendo esta. Deben hacerse esfuerzos para conseguir parámetros objetivos que aporten mayor nivel de correlación (AU)

Introduction: Although polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms. Objective: To evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment. Material and methods: We compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up. Results: Before surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=0.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=0.047). Conclusion: Despite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation (AU)

Clinical and polysomnographic correlation in sleep-related breathing disorders in children.

INTRODUCTION: Although polysomnography is the gold standard test for sleep-disordered breathing in children, there is controversy about its indication in all cases. Among the arguments both for and against is the lack of correlation between objective values and the symptoms. OBJECTIVE: To evaluate the correlation between clinical data and apnea-hypopnoea index (AHI) in our work environment. MATERIAL AND METHODS: We compared the preoperative clinical symptoms and AHI statistically in 170 children with sleep-disordered breathing who underwent polysomnography. We also analysed the correlation to postoperative level, with a subgroup of 80 children who underwent adenotonsillectomy with 1 year of polysomnography follow-up. RESULTS: Before surgery, only the degree of tonsillar hypertrophy was statistically significant correlated with AHI. At post-operative follow-up, evidence of correlation between AHI and apnoea was observed: 38.1% of children improved in the group with persistence and 66.7% in the disease resolution group (P=.023). In addition, the correlations showed the level of improvement of snoring, as assessed by visual analogue scale. The mean was 5 points lower in the persistent group and 6.1 lower in the disease resolution group (P=.047). CONCLUSION: Despite the limitations in the correlation between clinical data and polysomnography, especially in preoperative results, polysomnography remains the gold standard diagnostic tool. Efforts should be made to obtain objective parameters that provide higher levels of correlation.

Proton-pump inhibitors in sleep-related breathing disorders: clinical response and predictive factors.

BACKGROUND AND AIM: Gastroesophageal reflux is frequently associated with sleep-related breathing disorders. We aimed to evaluate the prevalence of acid reflux in patients with sleep-related breathing disorders, their clinical response to proton-pump inhibitor (PPI) treatment, and to identify predictive response factors to this treatment. METHODS: Prospective study among patients attending a sleep clinic. Evaluation of typical and atypical gastroesophageal reflux symptoms, simultaneous 24 h dual-channel pH monitoring and polysomnography were performed in all patients. Patients were treated with pantoprazole. After 3-6 months clinical response was evaluated, and pHmetry and polysomnography repeated. Clinical response was defined in terms of snore, apnea and somnolence grading. Improvement in polysomnography was defined by the Stanford criteria. RESULTS: One hundred and ninety-nine patients were included. Abnormal reflux levels were detected in the distal esophagus in 72% of patients, and in the proximal esophagus in 46%. Clinical or polysomnographic response to PPI treatment was found in 78% of patients. Pretreatment pHmetry was a significant predictor of success: 67% of responders had pathological proximal pHmetry (vs. 33% of nonresponders; P<0.001), and 55% also had pathological distal pHmetry (P<0.05). Age, sex, BMI, alcohol or tobacco abuse, typical or atypical gastroesophageal reflux symptoms, severity of sleeping disorder, and polysomnography were not predictive of outcome. CONCLUSIONS: Patients with sleep-related breathing disorders have an increased prevalence of gastroesophageal reflux disease. They may be successfully treated with PPIs, particularly in patients with an abnormal proximal esophageal pHmetry.

[Undiagnosed (corrected) cases of obstructive sleep apnoea syndrome: a new reason for involvement of otorhinolaryngologists]. / Casos no diagnosticados de síndrome de apnea obstructiva del sueño: un nuevo motivo de implicación para el otorrinolaringólogo.

INTRODUCTION: In Spain there are around 2 million people with obstructive sleep apnoea syndrome who should be treated. However, less than 10 % have been diagnosed and treated. Untreated patients are associated with a higher risk of cardiovascular and neurological complications, higher accident rates, reduced quality of life and greater health-care consumption. It is necessary, therefore, to reduce these consequences through early diagnosis and treatment. OBJECTIVE: To demonstrate the usefulness of a simple series of questions and examination as a mechanism to detect patients with undiagnosed obstructive sleep apnoea syndrome, in a consultation with a general otorhinolaryngologist. MATERIAL AND METHOD: Five hundred two consecutive patients coming to an otorhinolaryngological consultation for reasons other than sleep pathology were submitted to a series of questions and an examination of upper aerodigestive tract, to search for indications of suspected sleep apnoea. For the different clinical and anatomical comparisons, a control group of 178 consecutive already-diagnosed patients was used. RESULTS: Of the 502 cases, 74 (14.7%) fulfilled the requirements for suspicion and 35 of them agreed to take a polysomnograph test (47.29%). Of this group, an apnoea/ hypopnoea index greater than 5 was found in 24 of the 35 cases (4.78%). CONCLUSIONS: The prevalence of obstructive sleep apnoea in the group of patients studied is greater than that of the general population. With a simple interview and physical examination, a high rate of success can be obtained in the detection of undiagnosed sleep apnoea cases.

Casos no diagnosticados de síndrome de apnea obstructiva del sueño: un nuevo motivo de implicación para el otorrinolaringólogo / Diagnosed cases of obstructive sleep apnoea syndrome: a new reason for involvement of otorhinolaryngologists

Introducción: En España hay alrededor de 2 millones de sujetos portadores de un síndrome de apnea obstructiva del sueño subsidiarios de tratamiento. Sin embargo, tan sólo se ha diagnosticado y tratado menos del 10 %. Los pacientes no tratados tienen un riesgo superior de complicaciones cardiovasculares y neurológicas, mayor accidentabilidad, reducción en calidad de vida y mayores consumos sanitarios. Es necesario, por tanto, reducir estas consecuencias mediante un diagnóstico y un tratamiento precoces. Objetivo: Demostrar la utilidad de un interrogatorio y una exploración sencillos, como mecanismo de detección de pacientes con síndrome de apnea obstructiva del sueño no diagnosticado, en una consulta de otorrinolaringología general. Material y metodo: A 502 pacientes consecutivos, que acuden a la consulta de otorrinolaringología por un motivo diferente de patología de sueño, se los somete a un interrogatorio y la exloración de vías aerodigestivas altas en busca de criterios de sospecha de apnea del sueño. Los casos con sospecha clínica son invitados a realizar una polisomnografía nocturna. Para las diferentes comparaciones clínicas y anatómicas se ha utilizado un grupo control de 178 pacientes consecutivos ya diagnosticados. Resultados: De los 502 casos, 74 (14,7 %) cumplen los requisitos de sospecha y 35 (47,29 %) de ellos acceden a la práctica de la polisomnografía. En este último grupo se obtuvo un índice de apnea/hipopnea (IAH) superior a 5, en 24 de los 35 casos (4,78 %). Conclusiones: La prevalencia de apnea obstructiva del sueño en el grupo de pacientes analizados es superior a la de la población general. Con un sencillo interrogatorio y la exploración física, se puede obtener un alto rendimiento en la detección de casos no diagnosticados de apnea del sueño (AU)

Introduction: In Spain there are around 2 million people with obstructive sleep apnoea syndrome who should be treated. However, less than 10 % have been diagnosed and treated. Untreated patients are associated with a higher risk of cardiovascular and neurological complications, higher accident rates, reduced quality of life and greater health-care consumption. It is necessary, therefore, to reduce these consequences through early diagnosis and treatment. Objective: To demonstrate the usefulness of a simple series of questions and examination as a mechanism to detect patients with undiagnosed obstructive sleep apnoea syndrome, in a consultation with a general otorhinolaryngologist. Material and method: Five hundred two consecutive patients coming to an otorhinolaryngological consultation for reasons other than sleep pathology were submitted to a series of questions and an examination of upper aerodigestive tract, to search for indications of suspected sleep apnoea. For the different clinical and anatomical comparisons, a control group of 178 consecutive already-diagnosed patients was used. Results: Of the 502 cases, 74 (14.7 %) fulfilled the requirements for suspicion and 35 of them agreed to take a polysomnograph test (47.29 %). Of this group, an apnoea/ hypopnoea index greater than 5 was found in 24 of the 35 cases (4.78 %). Conclusions: The prevalence of obstructive sleep apnoea in the group of patients studied is greater than that of the general population. With a simple interview and physical examination, a high rate of success can be obtained in the detection of undiagnosed sleep apnoea cases (AU)