Introduction: The role of the renin-angiotensin-aldosterone system (RAAS) on the association obst... more Introduction: The role of the renin-angiotensin-aldosterone system (RAAS) on the association obstructive sleep apnea (OSA) and resistant hypertension (RH) is unclear. Aim: To analyze the effect of CPAP on 24-h blood pressure monitoring (ABPM) and on serum aldosterone in RH patients. Methods: 102 patients with an OSA15 and office-RH were randomized to CPAP (n=50) or to conventional treatment (n=52) for 3 months. 24-h ABPM and serum aldosterone were measured. 78 patients completed the follow-up (36 CPAP, 42 conventional treatment). Results: 66.7% were male, aged 58.27±9.3yrs and AHI 50.1±21.6, without significant differences between both groups. Serum aldosterone and AHI correlated significantly in patients with ABPM-confirmed RH (r= 0.25, p=0.02). CPAP achieved a significant decrease in serum aldosterone and 24-h BP decreased especially in those with ABPM-confirmed RH. Conclusion: The association between OSA and RH could be mediated at least in part by an effect on the RAAS.
Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysf... more Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysfunction, no randomised trials have assessed the impact of non-invasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography. We performed a secondary analysis of the data from the largest multicentre randomised controlled trial of OHS (Pickwick project, n=221) to determine the comparative efficacy of 2 months of NIV (n=71), CPAP (n=80) and lifestyle modification (control group, n=70) on structural and functional echocardiographic changes. Conventional transthoracic two-dimensional and Doppler echocardiograms were obtained at baseline and after 2 months. Echocardiographers at each site were blinded to the treatment arms. Statistical analysis was performed using intention-to-treat analysis. At baseline, 55% of patients had pulmonary hypertension and 51% had evidence of left ventricular hypertrophy. Treatment with NIV, but not CPAP, lowered systolic pulmo...
RATIONALE Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea ... more RATIONALE Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea (OSA) is treated with CPAP or noninvasive ventilation (NIV) during sleep. NIV is costlier, but may be advantageous because it provides ventilatory support. However, there are no long-term trials comparing these treatment modalities based on OHS severity. OBJECTIVE To determine if CPAP have similar effectiveness when compared to NIV according to OHS severity subgroups. METHODS Post hoc analysis of the Pickwick randomized clinical trial in which 215 ambulatory patients with untreated OHS and concomitant severe OSA, defined as apnoea-hypopnea index (AHI)≥30events/h, were allocated to NIV or CPAP. In the present analysis, the Pickwick cohort was divided in severity subgroups based on the degree of baseline daytime hypercapnia (PaCO2 of 45-49.9 or ≥50mmHg). Repeated measures of PaCO2 and PaO2 during the subsequent 3 years were compared between CPAP and NIV in the two severity subgroups. Statistical analysis was performed using linear mixed-effects model. RESULTS 204 patients, 97 in the NIV group and 107 in the CPAP group were analyzed. The longitudinal improvements of PaCO2 and PaO2 were similar between CPAP and NIV based on the PaCO2 severity subgroups. CONCLUSION In ambulatory patients with OHS and concomitant severe OSA who were treated with NIV or CPAP, long-term NIV therapy was similar to CPAP in improving awake hypercapnia, regardless of the severity of baseline hypercapnia. Therefore, in this patient population, the decision to prescribe CPAP or NIV cannot be solely based on the presenting level of PaCO2.
Sleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patien... more Sleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patients with diabetes. However, it is not known if there is an association between sleep apnea, circadian alterations and glycemic regulation in this type of patient. Here, a polysomnographic study was carried out on 21 women and 25 men (mean age = 64.3 ± 1.46 years) with diagnoses of type 2 diabetes to detect the presence of sleep apnea. Moreover, patients wore an actigraph and a temperature sensor on the wrist for one week, to study the manifestation of the circadian rhythms. The correlations of circadian and polysomnographic variables with the severity of apnea, measured by the apnea-hypopnea index, and with glycemic dysregulation, measured by the percentage of glycated hemoglobin, were analyzed. The mean apnea-hypoapnea index of all the participants was 39.6 ± 4.3. Apnea-hypoapnea index correlated with % N1, negatively with % N3, and also the stability of the active circadian rhythm. Howe...
Objectives This controlled trial assessed the effect of continuous positive airway pressure (CPAP... more Objectives This controlled trial assessed the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH). Methods We evaluated 96 patients with resistant hypertension, defined as clinic BP at least 140/90 mmHg despite treatment with at least three drugs at adequate doses, including a diuretic. Patients underwent a polysomnography and a 24-h ambulatory BP monitoring (ABPM). They were classified as consulting room or ABPM-confirmed resistant hypertension, according to 24-h BP lower or higher than 125/80 mmHg. Patients with an apnea-hypopnea index at least 15 events/h (n = 75) were randomized to receive either CPAP added to conventional treatment (n = 38) or conventional medical treatment alone (n = 37). ABPM was repeated at 3 months. The main outcome was the change in systolic and diastolic BP. Results Sixty-four patients completed the follow-up. Patients with ABPM-confirmed resistant hyper...
Non-restorative sleep is a hallmark symptom of chronic fatigue syndrome/myalgic encephalomyelitis... more Non-restorative sleep is a hallmark symptom of chronic fatigue syndrome/myalgic encephalomyelitis. However, little is known about self-reported sleep disturbances in these subjects. This study aimed to assess the self-reported sleep quality and its impact on quality of life in a Spanish community-based chronic fatigue syndrome/myalgic encephalomyelitis cohort. A prospective cross-sectional cohort study was conducted in 1,455 Spanish chronic fatigue syndrome/myalgic encephalomyelitis patients. Sleep quality, fatigue, pain, functional capacity impairment, psychopathological status, anxiety/depression and health-related quality of life were assessed using validated subjective measures. The frequencies of muscular, cognitive, neurological, autonomic and immunological symptom clusters were above 80%. High scores were recorded for pain, fatigue, psychopathological status, anxiety/depression, and low scores for functional capacity and quality of life, all of which correlated significantly ...
<p>The independent variables included in all analyses were: gender, age, BMI, basal SaO<... more <p>The independent variables included in all analyses were: gender, age, BMI, basal SaO<sub>2</sub> (log), neck circumference, waist circumference, somnolence score, and the presence or absence of T2D. AHI: apnea-hypopnea index; Beta: Standardized partial regression coefficient. ODI: oxygen desaturation index; BMI: body mass index.</p><p>Stepwise multiple linear regression analysis of variables associated with parameters obtained from the polysomnographic study in the whole population (n = 393 subjects).</p
Archivos de Bronconeumología ((English Edition)), 2008
To assess the cost-effectiveness of automatic continuous positive airway pressure (CPAP) titratio... more To assess the cost-effectiveness of automatic continuous positive airway pressure (CPAP) titration at home on 1 night or 2 consecutive nights in patients with the sleep apnea-hypopnea syndrome (SAHS). A home titration study was performed using automatic CPAP for 2 consecutive nights on 100 patients with SAHS and an indication for CPAP. The number of successful studies and the costs of the first night and both nights were analyzed. The pressure requirements on each night and the agreement between the pressures selected visually by 2 different observers were compared. CPAP titration was successful in 85% and 80% of patients on the first night and second night, respectively, and in 88% of patients after both nights. No significant differences between the 2 nights were found for the following parameters: 95th percentile pressure (mean [SD], 10.2 [1.8] cm H(2)O and 10.2 [1.6] cm H(2)O on the first and second nights, respectively), mean pressure (7.8 [1.7] cm H(2)O and 7.7 [1.7] cm H(2)O), or the pressure selected visually (9.4 [1.5] cm H(2)O and 9.4 [1.4] cm H(2)O). Interobserver agreement on the pressure selected was good: the k statistics were 0.956 for the first night and 0.91 for the second night. The 1-night study cost euro232.63 and the 2-night study cost euro227.93. Automatic CPAP titration at home for 1 night enables a substantially greater number of patients to be studied at a similar cost than is possible when titration is accomplished in 2 consecutive nights.
There is a strong association between sleep-disordered breathing (SDB) and obesity. However, ther... more There is a strong association between sleep-disordered breathing (SDB) and obesity. However, there are no studies addressed to determining the prevalence of SDB in morbidly obese premenopausal women, the most frequent group of patients requiring bariatric surgery. To evaluate the prevalence and characteristics of sleep apnea-hypopnea syndrome (SAHS) and obesity hypoventilation syndrome (OHS) in morbidly obese pre-menopausal women included in a program of bariatric surgery. A total of 88 consecutive morbidly obese pre-menopausal women (38.3 +/- 8.1 years, body mass index (BMI) 48.0 +/- 6.7 kg/m(2)) being evaluated for bariatric surgery at the outpatient obesity unit of a university hospital were prospectively recruited. SDB examinations included a non-attended respiratory polygraphy, pulmonary function testing, and an awake arterial gasometry. SAHS was defined as an apnea-hypopnea index (AHI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=10 events per hour and patients were divided in non-SAHS (AHI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10), mild (AHI: 10-20), moderate (AHI: 21-30), and severe (AHI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;30). OHS was defined as the presence of hypercapnia (PaCO(2) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 45). Somnolence was evaluated using the Epworth sleepiness scale. A total of 66 (75.0%) obese patients had SAHS: 25 (28.4%) mild, 14 (15.9%) moderate, and 27 (30.6%) severe. Seven (7.9%) obese patients presented OHS. Excessive daily somnolence was recorded in only 11 (16.6%) of the obese women with SAHS. In multiple regression analysis, BMI was the only variable independently associated with SAHS severity. Due to its high prevalence and severity, it should be recommended to investigate SDB in all morbidly obese pre-menopausal women awaiting bariatric surgery even in the absence of excessive daytime sleepiness.
The purpose of this study was to determine the frequency of obstructive sleep apnea in patients w... more The purpose of this study was to determine the frequency of obstructive sleep apnea in patients with inflammatory myopathy. An observational and prospective study was performed on a cohort of adult patients with inflammatory myopathy followed at a specialized outpatient clinic. Sixteen consecutive adult patients were evaluated by the Epworth Sleepiness Scale (ESS) and by complete polysomnography study. Disease activity and severity were assessed using the Myositis Disease Activity Assessment Tool (MDAAT) and Myositis Damage Index (MDI), respectively. Associations between sleep parameters and other factors were calculated using the chi-square test, Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact test, Mann-Whitney U-test, and Wilcoxon&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s test. A serum autoantibody profile was determined for all patients. The mean apnea-hypopnea index was 28.7 (23.8), and 14 patients (87%) had an apnea-hypopnea index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5. The mean frequency of respiratory arousals was 20.1 (12.5). Eleven (68%) patients reported frequently-always snoring, and 3 (19%) had excessive daytime sleepiness (ESS &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10). Seven patients were offered continuous positive airway pressure (CPAP) therapy; 4 tolerated the procedure well and reported a clear improvement in daytime sleepiness and/or sleep quality. No significant association was observed between the apnea-hypopnea index and clinical or immunological groups. Dysphagia, disease activity, and disease severity were not significantly associated with any sleep parameters. The frequency of obstructive sleep apnea in adult patients with inflammatory myopathy is high. The possibility that these alterations play a role in persistent fatigue in these patients cannot be ruled out.
Introduction: The role of the renin-angiotensin-aldosterone system (RAAS) on the association obst... more Introduction: The role of the renin-angiotensin-aldosterone system (RAAS) on the association obstructive sleep apnea (OSA) and resistant hypertension (RH) is unclear. Aim: To analyze the effect of CPAP on 24-h blood pressure monitoring (ABPM) and on serum aldosterone in RH patients. Methods: 102 patients with an OSA15 and office-RH were randomized to CPAP (n=50) or to conventional treatment (n=52) for 3 months. 24-h ABPM and serum aldosterone were measured. 78 patients completed the follow-up (36 CPAP, 42 conventional treatment). Results: 66.7% were male, aged 58.27±9.3yrs and AHI 50.1±21.6, without significant differences between both groups. Serum aldosterone and AHI correlated significantly in patients with ABPM-confirmed RH (r= 0.25, p=0.02). CPAP achieved a significant decrease in serum aldosterone and 24-h BP decreased especially in those with ABPM-confirmed RH. Conclusion: The association between OSA and RH could be mediated at least in part by an effect on the RAAS.
Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysf... more Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysfunction, no randomised trials have assessed the impact of non-invasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography. We performed a secondary analysis of the data from the largest multicentre randomised controlled trial of OHS (Pickwick project, n=221) to determine the comparative efficacy of 2 months of NIV (n=71), CPAP (n=80) and lifestyle modification (control group, n=70) on structural and functional echocardiographic changes. Conventional transthoracic two-dimensional and Doppler echocardiograms were obtained at baseline and after 2 months. Echocardiographers at each site were blinded to the treatment arms. Statistical analysis was performed using intention-to-treat analysis. At baseline, 55% of patients had pulmonary hypertension and 51% had evidence of left ventricular hypertrophy. Treatment with NIV, but not CPAP, lowered systolic pulmo...
RATIONALE Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea ... more RATIONALE Obesity hypoventilation syndrome (OHS) with concomitant severe obstructive sleep apnea (OSA) is treated with CPAP or noninvasive ventilation (NIV) during sleep. NIV is costlier, but may be advantageous because it provides ventilatory support. However, there are no long-term trials comparing these treatment modalities based on OHS severity. OBJECTIVE To determine if CPAP have similar effectiveness when compared to NIV according to OHS severity subgroups. METHODS Post hoc analysis of the Pickwick randomized clinical trial in which 215 ambulatory patients with untreated OHS and concomitant severe OSA, defined as apnoea-hypopnea index (AHI)≥30events/h, were allocated to NIV or CPAP. In the present analysis, the Pickwick cohort was divided in severity subgroups based on the degree of baseline daytime hypercapnia (PaCO2 of 45-49.9 or ≥50mmHg). Repeated measures of PaCO2 and PaO2 during the subsequent 3 years were compared between CPAP and NIV in the two severity subgroups. Statistical analysis was performed using linear mixed-effects model. RESULTS 204 patients, 97 in the NIV group and 107 in the CPAP group were analyzed. The longitudinal improvements of PaCO2 and PaO2 were similar between CPAP and NIV based on the PaCO2 severity subgroups. CONCLUSION In ambulatory patients with OHS and concomitant severe OSA who were treated with NIV or CPAP, long-term NIV therapy was similar to CPAP in improving awake hypercapnia, regardless of the severity of baseline hypercapnia. Therefore, in this patient population, the decision to prescribe CPAP or NIV cannot be solely based on the presenting level of PaCO2.
Sleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patien... more Sleep apnea, a condition that modifies sleep and circadian rhythms, is highly prevalent in patients with diabetes. However, it is not known if there is an association between sleep apnea, circadian alterations and glycemic regulation in this type of patient. Here, a polysomnographic study was carried out on 21 women and 25 men (mean age = 64.3 ± 1.46 years) with diagnoses of type 2 diabetes to detect the presence of sleep apnea. Moreover, patients wore an actigraph and a temperature sensor on the wrist for one week, to study the manifestation of the circadian rhythms. The correlations of circadian and polysomnographic variables with the severity of apnea, measured by the apnea-hypopnea index, and with glycemic dysregulation, measured by the percentage of glycated hemoglobin, were analyzed. The mean apnea-hypoapnea index of all the participants was 39.6 ± 4.3. Apnea-hypoapnea index correlated with % N1, negatively with % N3, and also the stability of the active circadian rhythm. Howe...
Objectives This controlled trial assessed the effect of continuous positive airway pressure (CPAP... more Objectives This controlled trial assessed the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with obstructive sleep apnea (OSA) and resistant hypertension (RH). Methods We evaluated 96 patients with resistant hypertension, defined as clinic BP at least 140/90 mmHg despite treatment with at least three drugs at adequate doses, including a diuretic. Patients underwent a polysomnography and a 24-h ambulatory BP monitoring (ABPM). They were classified as consulting room or ABPM-confirmed resistant hypertension, according to 24-h BP lower or higher than 125/80 mmHg. Patients with an apnea-hypopnea index at least 15 events/h (n = 75) were randomized to receive either CPAP added to conventional treatment (n = 38) or conventional medical treatment alone (n = 37). ABPM was repeated at 3 months. The main outcome was the change in systolic and diastolic BP. Results Sixty-four patients completed the follow-up. Patients with ABPM-confirmed resistant hyper...
Non-restorative sleep is a hallmark symptom of chronic fatigue syndrome/myalgic encephalomyelitis... more Non-restorative sleep is a hallmark symptom of chronic fatigue syndrome/myalgic encephalomyelitis. However, little is known about self-reported sleep disturbances in these subjects. This study aimed to assess the self-reported sleep quality and its impact on quality of life in a Spanish community-based chronic fatigue syndrome/myalgic encephalomyelitis cohort. A prospective cross-sectional cohort study was conducted in 1,455 Spanish chronic fatigue syndrome/myalgic encephalomyelitis patients. Sleep quality, fatigue, pain, functional capacity impairment, psychopathological status, anxiety/depression and health-related quality of life were assessed using validated subjective measures. The frequencies of muscular, cognitive, neurological, autonomic and immunological symptom clusters were above 80%. High scores were recorded for pain, fatigue, psychopathological status, anxiety/depression, and low scores for functional capacity and quality of life, all of which correlated significantly ...
<p>The independent variables included in all analyses were: gender, age, BMI, basal SaO<... more <p>The independent variables included in all analyses were: gender, age, BMI, basal SaO<sub>2</sub> (log), neck circumference, waist circumference, somnolence score, and the presence or absence of T2D. AHI: apnea-hypopnea index; Beta: Standardized partial regression coefficient. ODI: oxygen desaturation index; BMI: body mass index.</p><p>Stepwise multiple linear regression analysis of variables associated with parameters obtained from the polysomnographic study in the whole population (n = 393 subjects).</p
Archivos de Bronconeumología ((English Edition)), 2008
To assess the cost-effectiveness of automatic continuous positive airway pressure (CPAP) titratio... more To assess the cost-effectiveness of automatic continuous positive airway pressure (CPAP) titration at home on 1 night or 2 consecutive nights in patients with the sleep apnea-hypopnea syndrome (SAHS). A home titration study was performed using automatic CPAP for 2 consecutive nights on 100 patients with SAHS and an indication for CPAP. The number of successful studies and the costs of the first night and both nights were analyzed. The pressure requirements on each night and the agreement between the pressures selected visually by 2 different observers were compared. CPAP titration was successful in 85% and 80% of patients on the first night and second night, respectively, and in 88% of patients after both nights. No significant differences between the 2 nights were found for the following parameters: 95th percentile pressure (mean [SD], 10.2 [1.8] cm H(2)O and 10.2 [1.6] cm H(2)O on the first and second nights, respectively), mean pressure (7.8 [1.7] cm H(2)O and 7.7 [1.7] cm H(2)O), or the pressure selected visually (9.4 [1.5] cm H(2)O and 9.4 [1.4] cm H(2)O). Interobserver agreement on the pressure selected was good: the k statistics were 0.956 for the first night and 0.91 for the second night. The 1-night study cost euro232.63 and the 2-night study cost euro227.93. Automatic CPAP titration at home for 1 night enables a substantially greater number of patients to be studied at a similar cost than is possible when titration is accomplished in 2 consecutive nights.
There is a strong association between sleep-disordered breathing (SDB) and obesity. However, ther... more There is a strong association between sleep-disordered breathing (SDB) and obesity. However, there are no studies addressed to determining the prevalence of SDB in morbidly obese premenopausal women, the most frequent group of patients requiring bariatric surgery. To evaluate the prevalence and characteristics of sleep apnea-hypopnea syndrome (SAHS) and obesity hypoventilation syndrome (OHS) in morbidly obese pre-menopausal women included in a program of bariatric surgery. A total of 88 consecutive morbidly obese pre-menopausal women (38.3 +/- 8.1 years, body mass index (BMI) 48.0 +/- 6.7 kg/m(2)) being evaluated for bariatric surgery at the outpatient obesity unit of a university hospital were prospectively recruited. SDB examinations included a non-attended respiratory polygraphy, pulmonary function testing, and an awake arterial gasometry. SAHS was defined as an apnea-hypopnea index (AHI) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=10 events per hour and patients were divided in non-SAHS (AHI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10), mild (AHI: 10-20), moderate (AHI: 21-30), and severe (AHI &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;30). OHS was defined as the presence of hypercapnia (PaCO(2) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 45). Somnolence was evaluated using the Epworth sleepiness scale. A total of 66 (75.0%) obese patients had SAHS: 25 (28.4%) mild, 14 (15.9%) moderate, and 27 (30.6%) severe. Seven (7.9%) obese patients presented OHS. Excessive daily somnolence was recorded in only 11 (16.6%) of the obese women with SAHS. In multiple regression analysis, BMI was the only variable independently associated with SAHS severity. Due to its high prevalence and severity, it should be recommended to investigate SDB in all morbidly obese pre-menopausal women awaiting bariatric surgery even in the absence of excessive daytime sleepiness.
The purpose of this study was to determine the frequency of obstructive sleep apnea in patients w... more The purpose of this study was to determine the frequency of obstructive sleep apnea in patients with inflammatory myopathy. An observational and prospective study was performed on a cohort of adult patients with inflammatory myopathy followed at a specialized outpatient clinic. Sixteen consecutive adult patients were evaluated by the Epworth Sleepiness Scale (ESS) and by complete polysomnography study. Disease activity and severity were assessed using the Myositis Disease Activity Assessment Tool (MDAAT) and Myositis Damage Index (MDI), respectively. Associations between sleep parameters and other factors were calculated using the chi-square test, Fisher&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s exact test, Mann-Whitney U-test, and Wilcoxon&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s test. A serum autoantibody profile was determined for all patients. The mean apnea-hypopnea index was 28.7 (23.8), and 14 patients (87%) had an apnea-hypopnea index &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;5. The mean frequency of respiratory arousals was 20.1 (12.5). Eleven (68%) patients reported frequently-always snoring, and 3 (19%) had excessive daytime sleepiness (ESS &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;10). Seven patients were offered continuous positive airway pressure (CPAP) therapy; 4 tolerated the procedure well and reported a clear improvement in daytime sleepiness and/or sleep quality. No significant association was observed between the apnea-hypopnea index and clinical or immunological groups. Dysphagia, disease activity, and disease severity were not significantly associated with any sleep parameters. The frequency of obstructive sleep apnea in adult patients with inflammatory myopathy is high. The possibility that these alterations play a role in persistent fatigue in these patients cannot be ruled out.
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