Long-term gender-specific evolution of blood pressure under CPAP therapy in hypertensive patients with obstructive sleep apnea syndrome.

INTRODUCTION: Reduction of blood pressure (BP) under CPAP treatment in patients with obstructive sleep apnea syndrome (OSAS) associating hypertension (HT) is controversial and short-term evolution is often measured using the sphygmomanometer. PURPOSE: To study the variation in BP (sphygmomanometer and Holter) after 3 and 6 months of CPAP in OSAS patients associating hypertension. METHODS: We applied the exclusion criteria (hypoventilation, respiratory diseases, secondary hypertension, antihypertensive treatment modification during study, non-compliance) on 96 consecutive patients (SPSS 17.0: Chi test, T-test). RESULTS: 15 hypertensive patients (8.53 years from diagnosis) with OSAS succeeded six months of following: 3 women (20%), 12 men (80%) were comparable as age, body mass index and Epworth score; women had more severe OSAS. Sphygmomanometer measuring in men showed a decrease in systolic BP (SBP) (142 ± 8.9 to 128.7 ± 11.7 mmHg, p = 0.005) and diastolic BP (DBP) (82 ± 17.19 to 69.1 ± 6.6 mmHg, p = 0.040) at three months of treatment. Women had no changes at 3 and 6 months of assessment using the sphygmomanometer. BP Holter showed no significant changes in men; women exhibit a significant increase in maximum DBP/24 hours (104 ± 13.4 to 169.5 ± 27.5 mmHg, p = 0.034) and mean daytime DBP/24 hours (100 ± 14.1 to 166 ± 32.5 mmHg, p = 0.046) from 3 to 6 months. No group presents dipper status change to 3 or 6 months. CONCLUSIONS: The trend in both groups of increase in BP for 3 to 6 months is explained by the natural evolution of an old HT history. Long time monitoring using Holter device is more accurate in assessing cardiovascular risk.

Alpha-1 antitrypsin deficiency, SZ phenotype: a rare type of a rare disease. Case report.

Alpha-1 antitrypsin deficiency is one of the genetic diseases with a clear impact on the structure and function of the lung, rarely diagnosed and treated. We present the case of a 51-year-old female patient, heavy smoker, known with chronic obstructive pulmonary disease (COPD) for 12 years, untreated, who was hospitalized for the first time in our clinic having symptoms of a severe COPD exacerbation. She has significant cardiac disease (rheumatic mitral disease, with previous episodes of pulmonary edema and cardiac arrest) and hepatitis B. The patient is hypoxic, with severe mixed ventilatory dysfunction. During the hospitalisation she received treatment of the exacerbation and after that she received recommendation of chronic inhaled bronchodilator and corticosteroid treatment. The test for alpha-1 antitrypsin deficiency has detected a plasma of 63 mg/dl, SZ phenotype. The patient returns for a second evaluation. Functional tests are significantly improved (despite inconsistent treatment) with the impressive improvement of FEV7 values and identification by plethysmography of a restrictive syndrome. Echocardiography identifies mitral valve changes likely rheumatic, severe pulmonary hypertension. Computer tomography was performed, highlighting discrete interstitial changes and denying the existence of emphysema. Marked increase in FEV1 values supported adding bronchial asthma to the list of diagnosis and recommendation to continue inhaled corticosteroid combination bronchodilator as treatment. The particularity of the case is the rare phenotype, association of asthma and COPD as the clinical manifestation and the presence of comorbidities, which complicates the diagnosis and prognosis.

Obstructive sleep apnea syndrome and arterial hypertension--a complicated relationship? The role of controlling blood pressure values in patients with OSAS.

BACKGROUND: Arterial hypertension (HT) and obstructive sleep apnea syndrome (OSAS) are associated through cause-effect relationship. We aimed to study the effect of medication controlled hypertension on OSAS patients. METHODS: From 483 followed patients with OSAS, 252 associating HT; 142 patients of them (56.34%) received antihypertensive medication, 59 patients (41.54%) had controlled HT, 83 patients (58.46%) had uncontrolled HT. Demographic and anthropometric data, OSAS symptoms, comorbidities, apnea index (IA), apnea-hypopnea index (IAH), desaturation index, CPAP titration, CPAP failure rate were studiated regarding differences between patients with controlled and uncontrolled HT. RESULTS: Fifty nine patients with controlled HT were: 20 women (33.9%), 39 men (66.1%), with mean age of 56.08 years +/- 11.33, with an average AHI of 53.61 +/- 34.42/hour, an average of CPAP pressure prediction of 10.15 +/- 243 cm H2O. Eighty three patients with uncontrolled HT were: 18 women (21.7%), 65 men (78.3%), with mean age 55 +/- 9.06 years, with an average AHl of 61.91 +/- 43.61/hour, an average of CPAP pressure prediction of 10.47 +/- 2cm H2O. Comparing with the controlled HT group, patients with uncontrolled HT reported morning headaches, morning fatigue and impotency in a higher rate (p = 0.020, 0.018, 0.011 respectively); Epworth Sleepiness Scale was under 10 (cut-off for daytime sleepiness) in patients with controlled HT(p = 0.001) and higher in those with uncontrolled HT. Patients with uncontrolled HT were diagnosed with HT for a longer period (p = 0.006), had higher values of systolic and diastolic blood pressure at the time of the presentation. Statistically significant differences were found only for AHI post-CPAP (11.89/h vs. 22.30/h, p = 0.013) and nocturnal desaturation index post-CPAP (6.03/h vs. 16.55/h, p = 0.017), both higher in patients with uncontrolled HT. The hypothesis regarding existing differences related to the cardiovascular comorbidities was not supported. CONCLUSIONS: Controlled blood pressure deletes sleepiness, a defining symptom for OSAS and reduces remaining symptoms (headaches, impotency and morning fatigue). Presence of OSAS symptoms is less common in the controlled HT group, making the OSAS more difficult to suspect. These patients may have a grater benefit from CPAP therapy--they have AHI post-CPAP and desaturations post-CPAP significantly lower than patients with uncontrolled HT.

[Left pulmonary agenesis diagnosed late]. / Agenezie pulmonara stânga diagnosticata tardiv.

We present the case of a 51 years old female-patient, with severe dextroscoliosis, having like unique symptom progressive dyspnea. The blood samples reveals polycythemia, the radiological exam shows the opacification of 2/3 of the left thorax, the absence of the lung structure in the other 1/3, the deviation of the mediastinum, and dextroscoliosis; the computed tomography reveals the absence of the left lung artery and the left airways, compensatory hyperinflation of the right lung and dilatation of the trunk and right pulmonary artery; the bronchoscopy does not visualize the carina or the left main bronchus, typical for pulmonary agenesis. Echocardiography confirmed the absence of left pulmonary artery and shows mild pulmonary hypertension (systolic pressure in the pulmonary artery of 33 mmHg) with dilatation of the right cavities, but good cinetics. We face a case of pulmonary agenesis lately diagnosed, with modest functional cardiologic implications, limited therapeutic options and good survival, justified by the late appearance of the pulmonary hypertension of low severity and without worsening in time.