Combination of oximetry and sleep questionnaires as screening tools for CPAP initiation in patients with obstructive sleep apnea.

OBJECTIVES: Obstructive sleep apnea syndrome (OSA) is a cause of high morbidity and mortality so diagnosis and treatment is essential. Questionnaires and oximetry have been used for OSA screening. AIM: To evaluate the clinical utility of different sleep questionnaires (Stop Bang (S-B), Berlin (BQ), Epworth Sleepiness Scale (ESS)) in deciding on treatment with Continuous Positive Airway Pressure (CPAP) and to examine whether the combination of the questionnaires alone or with oximetry improves their predictive value for CPAP initiation. METHODS: Patients visiting a Sleep Clinic were prospectively studied. They completed the questionnaires. Home oximetry and in laboratory polysomnography (PSG) were performed within 3-20 days. Patients received CPAP if they were symptomatic with AHI≥5 or had AHI>15. RESULTS: 204 patients were studied (77.5%males, mean age 51.8±13.8 years, BMI 32.8±6.2kg/m2). There was a good correlation between Oxygen Desaturation Index of oximetry (ODIox) and ODI of PSG (r=0.95, p<0.0001) and between ODIox and AHI (r=0.811, p<0.0001). ODIox≥15 presented sensitivity 89.3%, specificity 83.5%, PPV 87% NPV 86.4% for CPAP initiation. ESS had the best specificity (68.6%) and PPV (68.6%) and S-B had the highest sensitivity (98%) and NPV (80%) but the lowest specificity (11%) for CPAP initiation. The combination of different questionnaires or questionnaires with oximetry did not improve their predictive value for CPAP initiation. CONCLUSIONS: Oximetry accurately predicted CPAP initiation. Questionnaires alone had limited value as screening tools for CPAP initiation; the combination of oximetry with questionnaires did not improve their predictive value.

Respiratory effects in workers processing dried tobacco leaves.

OBJECTIVES: The aim of this study was to examine the pollution level of the occupational environment and to investigate the effects of occupational exposure to tobacco dust on the respiratory system of tobacco workers. No such study has previously been conducted in Greece, which is one of the main tobacco-producing countries. METHODS: A total of 1,020 seasonal and permanent tobacco workers (188 men and 832 women) were studied in a factory in Thessaloniki. The study included: 1) completion of a questionnaire (British Medical Research Council 1986), 2) spirometry and 3) rhinomanometry. At the same time, tobacco dust levels in the working environment were measured. As controls, 469 workers (87 men and 382 women) at a Thessaloniki hospital were used. Seventy six workers with nasal symptoms underwent: 1) special nasal provocation test with tobacco dust antigen, 2) skin prick tests, and 3) measurement of total IgE, specific IgE and specific IgG against tobacco protein. RESULTS: Very high levels of total suspended dust were found in work site air (45.3-54.4 mg/m3). The prevalence of chronic bronchitis was 8.7 % versus 20.6 % in controls. Chronic obstructive pulmonary disease was found in 13 workers (1.3 %) and in 16 controls (3.4 %). FEV1 %pred, FVC %pred and the FEV1/FVC ratio were lower in controls, whereas FEF25-75 % %pred was lower in workers. There were no workers with bronchial asthma or extrinsic allergic alveolitis. Rhinitis was reported by 27.3 % of the workers versus 17.9 % of controls, whereas nasal flows were 563+/-211 versus 645 +/- 321 ml/sec, respectively. According to the results of skin prick tests, six workers were sensitized to dried tobacco leaf dust. CONCLUSIONS: The results of our study do not support an association between the development of chronic diseases of the lower respiratory system and pollutants associated with the processing of dried tobacco leaves. In contrast, an association between disorders of the upper airways and tobacco dust in work sites is postulated.

Respiratory effects in workers processing dried tobacco leaves

Objectives: The aim of this study was to examine the pollution level of the occupational environment and to investigate the effects of occupational exposure to tobacco dust on the respiratory system of tobacco workers. No such study has previously been conducted in Greece, which is one of the main tobacco-producing countries. Methods: A total of 1,020 seasonal and permanent tobacco workers (188 men and 832 women) were studied in a factory in Thessaloniki. The study included: 1) completion of a questionnaire (British Medical Research Council 1986), 2) spirometry and 3) rhinomanometry. At the same time, tobacco dust levels in the working environment were measured. As controls, 469 workers (87 men and 382 women) at a Thessaloniki hospital were used. Seventy six workers with nasal symptoms underwent: 1) special nasal provocation test with tobacco dust antigen, 2) skin prick tests, and 3) measurement of total IgE, specific IgE and specific IgG against tobacco protein. Results: Very high levels of total suspended dust were found in work site air (45.3-54.4 mg/m3). The prevalence of chronic bronchitis was 8.7 % versus 20.6 % in controls. Chronic obstructive pulmonary disease was found in 13 workers (1.3 %) and in 16 controls (3.4 %). FEV1 %pred, FVC %pred and the FEV1/FVC ratio were lower in controls, whereas FEF25-75 % %pred was lower in workers. There were no workers with bronchial asthma or extrinsic allergic alveolitis. Rhinitis was reported by 27.3 % of the workers versus 17.9 % of controls, whereas nasal flows were 563±211 versus 645 ± 321 ml/sec, respectively. According to the results of skin prick tests, six workers were sensitized to dried tobacco leaf dust. Conclusions: The results of our study do not support an association between the development of chronic diseases of the lower respiratory system and pollutants associated with the processing of dried tobacco leaves. In contrast, an association between disorders of the upper airways and tobacco dust in work sites is postulated (AU)

Objetivos: El propósito del estudio era examinar el nivel de contaminación del entorno de trabajo e investigar los efectos de la exposición laboral al polvo de tabaco sobre el aparato respiratorio de los trabajadores de la industria tabacalera. Fue el primer estudio de estas características realizado en Grecia, uno de los principales países productores de tabaco. Métodos: Se estudiaron los casos de 1.020 trabajadores temporales y permanentes de la industria tabacalera (188 hombres y 832 mujeres) en una fábrica de Tesalónica. El estudio consistió en los siguientes pasos: 1) cumplimentar un cuestionario (Consejo Bri- tánico de Investigaciones Médicas, 1986); 2) espirometría, y 3) rinomanometría. Al mismo tiempo, se midieron los niveles de polvo de tabaco en el entorno de trabajo. Se emplearon como controles 469 trabajadores (87 hombres y 382 mujeres) del hospital de Tesalónica. Se sometieron 76 trabajadores con síntomas nasales a los siguientes procedimientos: 1) prueba de provocación nasal especial con polvo de tabaco como antígeno; 2) pruebas cutáneas, y 3) medición de la IgE total, la IgE específica y la IgG específica contra proteína de tabaco. Resultados: En el aire del entorno de trabajo se observaron niveles muy elevados de polvo suspendido total (45,3-54,4 mg/m3). La prevalencia de la bronquitis crónica era del 8,7 por ciento, frente al 20,6 por ciento de los controles. Se observó enfermedad pulmonar obstructiva crónica (EPOC) en 13 trabajadores (1,3 por ciento) y en 16 controles (3,4 por ciento). Los valores del porcentaje predicho de FEV1y FVC, así como el cociente FEV1/FVC resultaron inferiores en los controles, mientras que el porcentaje predicho de FEF25-75 por ciento era inferior en los trabajadores. Ningún trabajador presentaba asma bronquial ni alveolitis alérgica extrínseca. Se observó rinitis en un 27,3 por ciento de los trabajadores frente al 17,9 por ciento de los controles, mientras que los flujos nasales resultaron ser de 563ñ211 frente a 645ñ321 ml/seg, respectivamente. Según las pruebas cutáneas, 6 trabajadores presentaban sensibilidad al polvo de las hojas secas de tabaco. Conclusiones: Los resultados de nuestro estudio no respaldan una relación entre el desarrollo de enfermedades crónicas del tracto respiratorio inferior y los contaminantes asociados a la manipulación de hojas secas de tabaco. En cambio, se postula una asociación entre los trastornos del tracto respiratorio superior y el polvo de tabaco de los entornos de trabajo (AU)

High ventilatory response to hypoxia in hypertensive patients with sleep apnea.

The ventilatory response to hypoxia (VRH) in relation to daytime arterial blood pressure was studied in 37 patients with the sleep apnea syndrome (SAS). The patients were divided into hypertensives (n = 16) and normotensives (n = 21). The hypertensive group had a significantly higher VRH (ventilatory increase 1.48 1/min BTPS per percent decrease in arterial oxygen saturation) than the normotensive group (0.69 1/min/%, P less than 0.01). The observed difference raises the question whether a high chemoreceptor sensitivity to hypoxaemia can contribute in causing arterial hypertension among cases with SAS.