Introduction: Obstructive Sleep Apnea (OSA) is a widely prevalent disease characterized by frequent airway collapse. Impulse oscillometry (IOS) is a non-invasive tool that requires minimal collaboration and can be used to evaluate resistance airway changes, not yet fully studied in OSA patients. Aims: To evaluate correlation between IOS and polysomnography (PSG) parameters in patients with suspected OSA. Methods: A prospective study was performed. Patients from a portuguese university hospital with suspected OSA were evaluated. Clinical assessment, cardiorespiratory PSG, IOS and lung function tests were performed. Results: 22 patients were evaluated, 63.6% female, 58.4±12.6 years. Mean body mass index 32.1±6.3 Kg/m2. Most patients performed spirometry, mean FEV1/FVC: 76.9±18.6. OSA was diagnosed in 88.2% of patients, Apnea-Hypopnea Index(AHI) 19.0/h. 33.4% with severe OSA. 41.0% of patients were treated with APAP. There was a positive moderate correlation between R5 and ODI and Hypopnea Index (HI) (rs 0.47, p < 0.05 and rs 0.56 p < 0.05). The same was reported with R20 and Z5. No correlation was observed between R5% or R20% or X5 values. In both R5 and R20 values, correlation (r) values with AHI had a moderate strength, however didn't reach statistical significance (p=0.073 and p=0.069, respectively). After excluding patients with obstructive disease on spirometry, there was a moderate correlation between Rcentral, R20, R20% and AIH (p<0.05). Conclusion: R5 and R20 values are correlated with ODI and HI. The airway resistance related to obstructive events in the upper airway may explain the raised resistances in central airways detected by IOS.
New-onset insomnia (NOI) associated with nocturnal ventilatory support (NVS) is becoming a reality in clinical practice; however there is a lack of data about its prevalence. Our aim was to determine the prevalence of NOI in patients with obstructive sleep apnoea syndrome (OSAS) under NVS and its associated risk factors.Descriptive cross-sectional study of 80 patients with OSAS under NVS. We compared two groups, with and without NOI, considering demographic characteristics, disease features, and personality. Patients under anxiolytic and/or antidepressant medication, with a weight loss of 10% or greater, and with restless legs symptoms were excluded.Median age of patients was 60.0 (interquartile range (IQR) 10.0) years; 82.5% were male. Median initial Epworth Sleepiness Scale (ESS) and apnoea-hypopnoea index (AHI) were 12.5 (IQR 9.0) and 44.1 (IQR 22.4)/hr, respectively. The majority of patients (91.3%) were under auto-adjusting positive airway pressure (APAP). Insomnia at baseline was present in 30% of patients (n=24). Prevalence of NOI was 21.4% (12/56). Initial and/or intermediate insomnia were the most frequent subtypes (n=11). We found a statistically significant negative relation between NOI and pressure on 90% night-time (P(90)) (p=0.040).OSAS patients under NVS presented a high prevalence of NOI. Patients with NOI presented lower levels of pressure using NVS, compared to the others.
Introduction: Obstructive sleep apnea (OSA) patients (pts) are at increased risk of morbimortality. Recently, Baveno’s classification, a multicomponent grading system, integrating symptoms, comorbidities and end-organ damage (EOD) was proposed. Studies on the long-term evolution of OSA pts not candidates for PAP therapy at diagnosis are scarce. We evaluated the temporal variation of the Baveno’s Classification Group from OSA diagnosis to 5-years ahead. Methods: Of the 79-pts diagnosed with OSA in 2015, not candidates for PAP therapy, 76 were included. A phone questionnaire, including anthropometric measures, symptoms and comorbidities, was performed. Patients were classified into groups, according to Baveno’s classification, at diagnosis and 5 years later. Results: There were 76 pts (57.9% male, mean age of 51.9±10.1 years), with a median AHI of 9.0 (5.8-11.8); 43.4% were classified in group A and 56.6% in group B. After 5 years, the reclassification was: 56.6% in group A, 32.9% in group B, 2.6% in group C and 7.9% in group D. Half of the pts remained in the same group, 10.5% developed EOD. Pts with EOD were significantly older (p=0.007). There was a statistically significant relation between EOD and diabetes, dyslipidemia and HT. There weren’t significant differences regarding symptoms or PSG results between pts that developed or not EOD. A logistic regression model was built to predict the development of EOD over 5 years; older age and diabetes significantly predicted it. Conclusions: After 5 years, 50% of pts, not candidates for PAP at diagnosis, remained in the same Baveno group, and 10.5% developed EOD. Older age and diabetes were the most important factors to predict EOD.
Introduction:Recent studies have reported a high prevalence of obstructive sleep apnoea (OSA) among patients with diffuse parenchymal lung disease (DPLD), mainly idiopathic pulmonary fibrosis (IPF).Effective OSA treatment appears to have a positive impact on morbidity and mortality in these patients.However, poor compliance to positive airway pressure (PAP) treatment in fibrotic DPLD patients has been reported.The aims of our study were to characterize patients with fibrotic DPLD and OSA and to assess their compliance to PAP treatment.Methods: Forty-nine patients with fibrotic DPLD underwent level III polysomnography.Auto-adjusting PAP (APAP) treatment was proposed for those patients with moderate-to-severe OSA and those with mild OSA with daytime sleepiness and/or cardiovascular disease.The APAP treatment compliance was assessed after 1 month of therapy.Results: The distribution of the 49 fibrotic DPLD patients included was as follows: 21 with chronic hypersensitivity pneumonitis, 12 with IPF, 10 with connective-tissue associated DPLD, 4 with stage IV sarcoidosis, 1 with idiopathic pleuropulmonary fibroelastosis, and 1 with DPLD-associated vasculitis.Thirty-four (69.4%) of the patients presented with OSA; 22 had mild OSA, and 12 had moderate-to-severe OSA.APAP treatment was prescribed in 17 of the patients.After 1 month of therapy, all patients used APAP more than 70% of the nights for more than 4 h per night. Conclusion:We found a high prevalence of OSA among all of the patients with fibrotic DPLD (not only IPF).Despite certain difficulties, it was possible to achieve good APAP compliance in these patients.
Introduction: The WHO declared the COVID-19 outbreak as a pandemic. The ability to integrate telecommunications and information systems was crucial. Aims: To evaluate the usefulness of teleconsultations and telemonitoring in Sleep-disordered breathing (SDB) patient's follow-up. Methods: The study was conducted at the Sleep Lab of a tertiary university hospital between 13th march and 31st May 2020. All patients included were adults with suspected or confirmed SDB. In the first phone medical appointments, a clinical interview was conducted. In the follow-up teleconsultations, all patients had SDB and we analyzed adherence to treatment, control of respiratory sleep events, PAP-related side effects, and changes in therapeutic strategies. Results: A total of 769 phone consultations were performed. In first phone medical appointments (n=149), 109 patients answered the call. In follow-up teleconsultations (n=620), 89,7% answered the call and 86,8% were under PAP-therapy. Information of PAP devices was available in 354 cases; 79.1% of patients had adequate adherence and 76% had residual AHI≤5 events/h. A new therapeutic approach was more often started in patients with nasal congestion (p<.001), rhinorrhea (p<.001), and nosebleeds (p=0.03). Changes in previous therapy were more frequent in patients with nasal congestion (p<.001), rhinorrhea (p<.001), mucosal dryness (p<.001), and nosebleeds (p=0.02). Patients whose PAP settings were changed had a higher median residual AHI, median 5 (8) events/h vs median 2 (3) events/h, p<.001. Conclusions: Teleconsultation and telemonitoring of SDB patients are possible in most cases and allow the resolution of several side effects and therapeutic adjustments.
Background: Auto-titrating continuous positive airway pressure (APAP) devices have been developed to improve efficacy and compliance to treatment of patients with obstructive sleep apnea syndrome (OSAS). Since there are insufficient data on the optimal pressure range setting, we aimed in this study to compare the efficacy of treatment with high span versus low span APAP. Methods: Fifty-three newly diagnosed OSAS patients fulfilling the treatment criteria were randomized to receive high span (HS, range 4-15 cmH2O, n=25) or low span (LS, range 8-12 cmH2O, n=28) APAP. Patients were assessed at 1 and 3 months. Results: Mean (±SD) Epworth Sleepiness Scale (ESS) was 10.5±6.2 and median apnea-hypopnea index (AHI) was 31.9 (IQR, 23.1-46.4). There were no significant differences in gender distribution, age, body-mass index, cervical perimeter, ESS and AHI between groups. Overall, no significant differences were found at the 1st month assessment. After 3 months of APAP therapy, we again found no differences in air leakage or residual AHI. However, HS group proved less adherent than LS group, respectively with median 69.5% (IQR, 44-96) vs 96% (IQR, 83.5-98) of the nights using at least 4h (p=0.008) and mean usage 5.4±1.8 h/night vs 6.5±1.2 h/night (p=0.022). In LS group, 83.3% patients had 95th percentile pressure >11 cmH2O, although only 7.7% required to change maximum pressure setting beyond 12 cmH2O. Conclusions: Both pressure ranges appear to be equally effective to correct AHI and improve symptoms. However patients with high span APAP were less compliant to treatment, raising issues about the tolerability of wide pressure range settings of these devices.
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