Prevalencia de síntomas depresivos y diagnóstico de sospecha de depresión en pacientes con EPOC / Prevalence of Depressive Symptoms, Predictive Factors, and Diagnosis of Suspicion of Depression in Patients with COPD

Objetivo: Conocer la prevalencia y factores predictores de depresión en pacientes diagnosticados de enfermedad pulmonar obstructiva crónica (EPOC) y remitidos desde Atención Primaria a consultas de Neumología, servicios que comparten la atención al proceso EPOC.DiseñoEstudio observacional, multicéntrico, prospectivo con muestreo no probabilístico, transversal.EmplazamientoDos consultas de neumología de dos hospitales de diferente nivel asistencial.ParticipantesSe diagnosticaron 293 pacientes de EPOC en fase estable de la enfermedad.IntervencionesAplicación de cuestionarios clínicos habituales en la EPOC y test HADS (Hospital Anxiety and Depression Scale).VariablesVariables demográficas, clínicas y funcionales de la EPOC y escala de depresión del test HADS (Hospital Anxiety and Depression Scale).ResultadosSe incluyeron 229 hombres (78,16%) y 64 mujeres (21,8%), con una edad media de 68,2 ± 10,3 años, de los que 93 (31,7%) eran fumadores activos y 200 (68,3%) exfumadores. El 19,45% de los pacientes tenía diagnóstico clínico previo de depresión, pero mediante el test HADS se estableció el diagnóstico de sospecha en el 32,6%. Las variables predictoras fueron: ser mujer, vivir solo y variables relacionadas con la gravedad de la enfermedad (volumen espiratorio forzado en 1 segundo [FEV1] postbroncodilatador, ser paciente de riesgo y fenotipo agudizador según criterios de la Guía Española de la EPOC [GesEPOC] y grados C y D de criterios Global Initiative for Chronic Obstructive Lung Disease [GOLD]).ConclusionesLa prevalencia de la depresión en pacientes con EPOC es alta y está infradiagnosticada. El test diagnóstico HADS es útil para establecer el diagnóstico de sospecha en las consultas de Atención Primaria y Neumología.

Objective: to determine the prevalence of and predictive factors for depression in patients diagnosed with COPD and referred from primary care to pneumology departments, departments that share care for COPD patients.Designobservational, multicentric, prospective with non-probabilistic sample, transversal study.Settingtwo pneumology visit offices at two hospitals offering different levels of care.Participants293 patients diagnosed with COPD in a stable phase of the disease.InterventionsCarryng out common clinical questionnaires in COPD & HADS.Main measurementsDemographic, clinical, and functional variables of COPD, and HADS depression scale.ResultsIncluded were 229 men (78.16%) and 64 women (21.8%), with an average age of 68.2 ± 10.3 years of whom 93 (31.7%) were active smokers and 200 (68.3%) ex-smokers. 19.45% of patients had a previous diagnosis of clinical depression but the HADS test established a diagnosis of suspicion of depression in 32.6%. Predictive factors included: being female, living alone, and variables related to the severity of the disease (FEV1 postbronchodilator, being a high-risk patient, exacerbating phenotype criteria, and C and D GOLD criteria levels).ConclusionsThe prevalence of depression in patients with COPD is high and is infra-diagnosed. The HADS diagnostic test is useful for establishing a diagnosis of suspicion of depression at primary care and pneumology visit offices. There are personal and clinical factors that may be considered predictive and aid healthcare professionals in determining which patients should take the HADS test and, based on results, referring patients to the mental health department to confirm or reject the diagnosis.

[Prevalence of Depressive Symptoms, Predictive Factors, and Diagnosis of Suspicion of Depression in Patients with COPD]. / Prevalencia de síntomas depresivos y diagnóstico de sospecha de depresión en pacientes con EPOC.

OBJECTIVE: to determine the prevalence of and predictive factors for depression in patients diagnosed with COPD and referred from primary care to pneumology departments, departments that share care for COPD patients. DESIGN: observational, multicentric, prospective with non-probabilistic sample, transversal study. SETTING: two pneumology visit offices at two hospitals offering different levels of care. PARTICIPANTS: 293 patients diagnosed with COPD in a stable phase of the disease. INTERVENTIONS: Carryng out common clinical questionnaires in COPD & HADS. MAIN MEASUREMENTS: Demographic, clinical, and functional variables of COPD, and HADS depression scale. RESULTS: Included were 229 men (78.16%) and 64 women (21.8%), with an average age of 68.2 ± 10.3 years of whom 93 (31.7%) were active smokers and 200 (68.3%) ex-smokers. 19.45% of patients had a previous diagnosis of clinical depression but the HADS test established a diagnosis of suspicion of depression in 32.6%. Predictive factors included: being female, living alone, and variables related to the severity of the disease (FEV1 postbronchodilator, being a high-risk patient, exacerbating phenotype criteria, and C and D GOLD criteria levels). CONCLUSIONS: The prevalence of depression in patients with COPD is high and is infra-diagnosed. The HADS diagnostic test is useful for establishing a diagnosis of suspicion of depression at primary care and pneumology visit offices. There are personal and clinical factors that may be considered predictive and aid healthcare professionals in determining which patients should take the HADS test and, based on results, referring patients to the mental health department to confirm or reject the diagnosis.

Disfunción sinusal transitoria secundaria a tratamiento con lacosamida / Transient sinus dysfunction secondary to lacosamide treatment

RESUMEN Se presenta el caso de una paciente de 84 años de edad, con antecedentes de hipertensión arterial, dislipemia, insuficiencia venosa crónica y osteoartrosis, que -debido a una neuralgia del trigémino- había recibido tratamiento con varios fármacos, sin lograr control del dolor neuropático, por lo que se inició tratamiento con lacosamida en monoterapia, con incremento de dosis hasta lograr el objetivo terapéutico; pero la paciente presentó manifestaciones clínicas y alteraciones electrocardiográficas compatibles con disfunción sinusal, que se resolvieron tras la reducción de la dosis del fármaco.

ABSTRACT The case of an 84-year-old female patient is presented, with a history of high blood pressure, dyslipidemia, chronic venous failure and osteoarthritis, which -due to trigeminal neuralgia- had received treatment with several drugs, without achieving neuropathic pain control; that was why the treatment with lacosamide was started in monotherapy, with an increase in dose until the therapeutic objective was achieved; but the patient presented clinical manifestations and electrocardiographic alterations compatible with sinus dysfunction, which were solved after reducing the dose of the drug.

Ancho de distribución eritrocitaria en apnea obstructiva del sueño / Red cell distribution width in obstructive sleep apnea

Introducción. El ancho de distribución eritrocitaria (ADE) describe el grado de heterogeneidad en el tamaño de los hematíes. Un incremento de ADE se ha asociado con exceso de mortalidad en insuficiencia cardiaca y otras enfermedades crónicas. Dado que existe mayor riesgo de morbimortalidad cardiovascular en apnea obstructiva del sueño (AOS), es posible que estos pacientes presenten un ADE elevado. Método. Se reclutaron sujetos de 18 a 60 años remitidos a la Unidad de Trastornos Respiratorios del Sueño (UTRS) por sospecha de AOS. Se excluyeron sujetos con cualquier comorbilidad. En la poligrafía respiratoria se determinó el índice de apnea-hipopnea (IAH). El ADE se obtuvo a partir del hemograma. Al año de seguimiento se determinaron los cambios de ADE tras tratamiento con presión positiva continua en la vía respiratoria (CPAP). Resultados. Se incluyeron 34 sujetos sin AOS y 138 con AOS con una edad de 40,5 ± 9,8 y 45,6 ± 9,2 (p = 0,004) respectivamente. El ADE fue mayor en sujetos con AOS que en sujetos sanos: 13,40 (12,40-14,40) vs. 13,15 (12,07-14,23) (p=0,036). El IAH mostró una relación positiva e independiente con ADE tanto en el conjunto de la población (r = 0,223; p = 0,002) como en el grupo con AOS (r = 0,231; p = 0,005). No se observaron cambios significativos de ADE tras un año de tratamiento con CPAP. Conclusiones. El ADE está aumentado en AOS en relación directa con su gravedad, sin embargo, sus niveles no se ven modificados por el tratamiento efectivo de la AOS con CPAP

Introduction. Red cell distribution width (RDW) describes heterogeneity in the size of red blood cells. An increase in RDW has been associated with excess mortality in heart failure and other chronic diseases. Since there is an increased risk of cardiovascular morbidity and mortality in obstructive sleep apnea (OSA), it is possible that these patients have a high RDW. Method. We recruited subjects aged 18 to 60 years referred to the sleep-disordered breathing unit for suspected OSA. Subjects with any comorbidity were excluded. Apnea-hypopnea index (AHI) was calculated from the respiratory polygraphy. The RDW was obtained from the complete blood count. Changes in RDW after one year of treatment with continuous positive airway pressure (CPAP) were determined. Results. We included 34 healthy subjects and 138 with OSA, aged 40.5 ± 9.8 and 45.6 ± 9.2 (P = .004) years, respectively. The RDW was higher in subjects with OSA compared to healthy subjects: 13.40 (12.40 to 14.40) vs. 13.15 (12.07 to 14.23) (P = .036). AHI showed a positive independent relationship with RDW in both the whole population (r = 0.223; P = .002) and the OSA group (r = 0.231; P = .005). No significant changes were found in RDW after one year of CPAP therapy. Conclusions. RDW increase in patients with OSA is directly associated with severity, although levels are not modified by the effective treatment of OSA with CPAP

Red Cell Distribution Width in Obstructive Sleep Apnea. / Ancho de distribución eritrocitaria en apnea obstructiva del sueño.

INTRODUCTION: Red cell distribution width (RDW) describes heterogeneity in the size of red blood cells. An increase in RDW has been associated with excess mortality in heart failure and other chronic diseases. Since there is an increased risk of cardiovascular morbidity and mortality in obstructive sleep apnea (OSA), it is possible that these patients have a high RDW. METHOD: We recruited subjects aged 18 to 60 years referred to the sleep-disordered breathing unit for suspected OSA. Subjects with any comorbidity were excluded. Apnea-hypopnea index (AHI) was calculated from the respiratory polygraphy. The RDW was obtained from the complete blood count. Changes in RDW after one year of treatment with continuous positive airway pressure (CPAP) were determined. RESULTS: We included 34 healthy subjects and 138 with OSA, aged 40.5±9.8 and 45.6±9.2 (P=.004) years, respectively. The RDW was higher in subjects with OSA compared to healthy subjects: 13.40 (12.40 to 14.40) vs. 13.15 (12.07 to 14.23) (P=.036). AHI showed a positive independent relationship with RDW in both the whole population (r=0.223; P=.002) and the OSA group (r=0.231; P=.005). No significant changes were found in RDW after one year of CPAP therapy. CONCLUSIONS: RDW increase in patients with OSA is directly associated with severity, although levels are not modified by the effective treatment of OSA with CPAP.