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Sleep Apnea Syndromes: HELP
Articles from Miscellaneous institutions in Madrid
Based on 37 articles published since 2008
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These are the 37 published articles about Sleep Apnea Syndromes that originated from Miscellaneous institutions in Madrid during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Prevention, diagnosis, and treatment of obesity. 2016 position statement of the Spanish Society for the Study of Obesity. 2017

Lecube, Albert / Monereo, Susana / Rubio, Miguel Ángel / Martínez-de-Icaya, Purificación / Martí, Amelia / Salvador, Javier / Masmiquel, Lluís / Goday, Alberto / Bellido, Diego / Lurbe, Empar / García-Almeida, José Manuel / Tinahones, Francisco José / García-Luna, Pedro Pablo / Palacio, Enrique / Gargallo, Manuel / Bretón, Irene / Morales-Conde, Salvador / Caixàs, Assumpta / Menéndez, Edelmiro / Puig-Domingo, Manel / Casanueva, Felipe F. ·Servicio de Endocrinología y Nutrición, Unidad de Obesidad, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida, CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas, ISCIII), Universitat de Lleida, Lleida, España. Electronic address: alecube@gmail.com. · Servicio de Endocrinología y Nutrición, Hospital General Universitario Gregorio Marañón, Madrid, España. · Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Madrid, España. · Sección de Endocrinología y Nurición, Hospital Universitario Severo Ochoa de Leganés, Madrid, España. · Departamento de Ciencias de la Alimentación y Fisiología, Universidad de Navarra, CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, España. · Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, España. · Servicio de Endocrinología y Nutrición, Unidad de Obesidad, Hospital de Son Llàtzer, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IdISPa), Universitat de les Illes Balears, Palma de Mallorca, España. · Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España. · Servicio Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol (CHUF), SERGAS, Ferrol, A Coruña, España. · Departamento de Pediatría, Consorcio Hospital General. CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Universidad de Valencia, Valencia, España. · Complejo Hospitalario de Málaga (Virgen de la Victoria), Hospital Quirón-Salud Málaga, Universidad de Málaga, Málaga, España. · Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Clínico Virgen de la Victoria, CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Universidad de Málaga, Málaga, España. · Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España. · Servicio de Endocrinología y Nutrición, Hospital Universitario Nuestra Señora de Candelaria (HUNSC), Santa Cruz de Tenerife, España. · Servicio de Endocrinología y Nutrición, Hospital Virgen de la Torre, Madrid, España. · Unidad de Innovación Cirugía Mínima Invasiva, Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen del Rocío, Sevilla, España. · Servicio de Endocrinología y Nutrición, Hospital Universitari Parc Taulí de Sabadell, Corporació Sanitària Parc Taulí, Institut de Recerca I3PT, Universitat Autònoma de Barcelona, Sabadell, España. · Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias (HUCA). Departamento de Medicina, Universidad de Oviedo, Oviedo, España. · Servicio de Endocrinología y Nutrición, Hospital Germans Trias i Pujol, Badalona. Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España. · Departamento de Medicina, Universidad de Santiago, Compejo Hospitalario Universitario de Santiago (CHUS), CIBERobn (CIBER de Fisiopatología de la Obesidad y Nutrición, ISCIII), Santiago de Compostela, España. ·Endocrinol Diabetes Nutr · Pubmed #27543006.

ABSTRACT: -- No abstract --

2 Guideline Chronic Cough. 2015

Pacheco, Adalberto / de Diego, Alfredo / Domingo, Christian / Lamas, Adelaida / Gutierrez, Raimundo / Naberan, Karlos / Garrigues, Vicente / López Vime, Raquel. ·Servicio de Neumología, Hospital Ramón y Cajal, Madrid, España. Electronic address: apacheco.hrc@salud.madrid.org. · Servicio de Neumología, Hospital La Fe, Valencia, España. · Servicio de Neumología, Hospital Parc Taulí, Sabadell, Barcelona, España. · Servicio de Pediatría, Hospital Ramón y Cajal, Madrid, España. · Servicio de Otorrinolaringología, Hospital Rey Juan Carlos, Móstoles, Madrid, España. · Centro de Salud Belchite, Zaragoza, España. · Servicio de Gastroenterología, Hospital La Fe, Valencia, España. · Servicio de Neumología, Hospital Severo Ochoa, Madrid, España. ·Arch Bronconeumol · Pubmed #26165783.

ABSTRACT: Chronic cough (CC), or cough lasting more than 8 weeks, has attracted increased attention in recent years following advances that have changed opinions on the prevailing diagnostic and therapeutic triad in place since the 1970s. Suboptimal treatment results in two thirds of all cases, together with a new notion of CC as a peripheral and central hypersensitivity syndrome similar to chronic pain, have changed the approach to this common complaint in routine clinical practice. The peripheral receptors involved in CC are still a part of the diagnostic triad. However, both convergence of stimuli and central nervous system hypersensitivity are key factors in treatment success.

3 Clinical Trial An evaluation of indexes as support tools in the diagnosis of sleep apnea. 2012

Otero, Abraham / Félix, Paulo / Presedo, Jesús / Zamarrón, Carlos. ·Department of Information and Communications Systems Engineering, University San Pablo CEU, Boadilla del Monte, Km 5,300, Urbanización Montepríncipe, 28668 Madrid, Spain. abraham.otero@gmail.com ·Ann Biomed Eng · Pubmed #22374322.

ABSTRACT: This article evaluates several indexes as support tools to diagnose patients with Sleep Apnea-Hypopnea Syndrome (SAHS). Some of these indexes, such as the Apnea-Hypopnea Index, have been standardized and studied in depth in the literature. Other indexes are used extensively in the reports that commercial polysomnographs generate. However, they have not been studied in detail and clinicians have no standardized guidelines for interpreting them. Examples are the mean and maximum duration of apneas and hypopneas. Finally, several novel indexes proposed by the authors are also evaluated. To evaluate the indexes, we have used a database of 274 patients who have undergone a polysomnographic test. Several feature selection techniques were used to assess the capability of each index to discriminate between healthy and SAHS patients. The capability of the indexes for diagnosing the patients was analyzed by using decision trees which were trained using each index individually, and all the indexes together. Our results suggest that some indexes which are often present in the reports of commercial polysomnographs provide little or no information. On the other hand, other indexes that are usually not considered have a great capability to discern between SAHS and control patients.

4 Article Impact of Positive Pressure Treatment of the Airway on Health-Related Quality of Life in Elderly Patients With Obstructive Sleep Apnea. 2018

Serrano Merino, Jesús / Pérula de Torres, Luis Ángel / Bardwell, Wayne A / Muñoz Gómez, Rafaela / Roldán Villalobos, Ana / Feu Collado, Nuria / Ruiz-Moral, Roger / Jurado-Gámez, Bernabé / Anonymous5511006. ·1 Sleep Unit, Respiratory Department, University Hospital Reina Sofia, Córdoba, Spain. · 2 Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), University Hospital Reina Sofia, University of Córdoba, Córdoba, Spain. · 3 Unidad Docente de Medicina Familiar y Comunitaria, Health District of Córdoba and Guadalquivir, Córdoba, Spain. · 4 Department of Psychiatry, University of California, San Diego, CA, USA. · 5 Health District of Córdoba and Guadalquivir, Córdoba, Spain. · 6 Faculty of Medicine, University of Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain. · 7 Faculty of Medicine, University of Córdoba, Córdoba, Spain. ·Biol Res Nurs · Pubmed #29724113.

ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) is a chronic illness that increases in prevalence with age. Treatment includes continuous positive airway pressure (CPAP) devices. Studies about the use of CPAP in the elderly are scarce. The main objective of this study is to determine whether CPAP contributes to improvement in health-related quality of life (HRQL) in elderly patients with OSA. METHOD: This was a prospective, pre-/postintervention assessment of a cohort of patients ≥65 years of age with OSA diagnosis by polysomnography who were being treated with CPAP and were physically independent and had good cognitive status. We determined HRQL before and after 3 months of CPAP treatment using the Short Form-36 Health Survey (SF-36, a 36-item, patient-reported survey) and Sleep Apnea Quality of Life Index (SAQLI). The effect of CPAP on daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). RESULTS: Of the 103 participants with a mean age of 71.5 ± 4.19 years, 66% were male. After 3 months of therapy, the mean CPAP usage was 6.3 ± 1.41 hr/day. The effectiveness of CPAP in controlling the OSA was demonstrated (mean difference pre- and posttherapy: 34.30 ± 18.52 events/hr, p < .001). Postintervention, the categories of the SF-36 improved meaningfully ( p < .001). Moreover, all categories of SAQLI improved ( p < .001) with the exception of "symptoms" ( p = .073). ESS scores also improved significantly (difference = 5.2 ± 4.47, p < .001) postintervention. CONCLUSION: Therapy with CPAP in elderly patients with OSA helps improve their HRQL and reduces daytime sleepiness.

5 Article [Clinical and neuropsychological characteristics in congenital central hypoventilation syndrome]. 2018

Seijas-Gomez, R / Esteso-Orduna, B / Melero-Llorente, J / Fournier-Del Castillo, M C. ·Hospital Universitario Son Espases, Palma de Mallorca, Espana. · Hospital Psiquiatrico Casta Guadarrama, Guadarrama, Espana. · Hospital Infantil Universitario Nino Jesus, 28009 Madrid, Espana. ·Rev Neurol · Pubmed #29696617.

ABSTRACT: INTRODUCTION: Congenital central hypoventilation syndrome (CCHS) syndrome is a rare disease caused by mutations in the PHOX2B gene. Patients show a reduced response to hypercapnia and hypoxia accompanied by diffuse disturbances of the autonomic nervous system and occasionaly also disturbances in neuroimaging. A specific neuropsychological profile has not been described in children and adolescents with CCHS. CASE REPORTS: We describe three cases (aged between 4 and 19 years) with different profiles of affectation in cognitive and functionality. These profiles are compared with the features described in the literature about neuropsychology in CCHS. CONCLUSIONS: The profile of functional impairment in the CCHS is variable: in case 1, a severe global developmental delay with autistic features and marked functional involvement is described. In case 2, bilateral atrophy of the hippocampus is associated with involvement in social cognition and in executive functions with moderate functional repercussion. Case 3 shows difficulties in some cognitive executive functions (planning and non-verbal fluency), but without functional repercussion. Neuropsychological assessment can help in the clinical management of these patients by determining and guiding the need for rehabilitation treatments.

6 Article Neuropsychological profile and social cognition in congenital central hypoventilation syndrome (CCHS): Correlation with neuroimaging in a clinical case. 2018

Esteso Orduña, Borja / Seijas Gómez, Raquel / García Esparza, Elena / Briceño, Emily M / Melero Llorente, Javier / Fournier Del Castillo, María de la Concepción. ·a Half-Stay Unit for Adolescents with Severe Mental Disorder , Hospital Psiquiátrico Casta Guadarrama , Guadarrama , Madrid , Spain. · b Instituto Balear de Salud Mental de la Infancia y Adolescencia , Hospital Universitario Son Espases , Palma de Mallorca , Spain. · c Diagnostic Imaging Service , Hospital Universitario Infantil Niño Jesús , Madrid , Spain. · d Department of Physical Medicine & Rehabilitation, Rehabilitation Psychology & Neuropsychology Division , University of Michigan , Ann Arbor , MI , USA. · e Neuropsychology Unit, Psychiatry and Psychology Service , Hospital Universitario Infantil Niño Jesús , Madrid , Spain. ·J Clin Exp Neuropsychol · Pubmed #28708033.

ABSTRACT: INTRODUCTION: Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder due to paired-like homeobox gene (PHOX2B) mutations. CCHS patients suffer from dysregulation of the autonomic nervous system characterized by the absence of or extremely reduced response to hypercapnia and hypoxia, with neuropsychological deficits. The aim of this exploratory study is to describe the longitudinal neuropsychological profile and its correlations with magnetic resonance imaging (MRI) of a child with CCHS with a PHOX2B mutation. METHOD: A comprehensive neuropsychological evaluation was conducted serially at age 7 years 4 months and 10 years 3 months, including assessment of intellectual functioning (IQ), motor functioning, perception, attention, executive functions, language, memory, social cognition, academic skills, and psychopathology. Reliable change index (RCI) scores were used to assess changes between assessments. We collected spin lattice relaxation time (T1)-weighted, fluid-attenuated inversion recovery (FLAIR), and spin spin lattice relaxation time (T2)-weighted images from the child at age 10 years 3 months using a 1.5-tesla MRI scanner. RESULTS: IQ, processing speed index (PSI), social cognition (theory of mind and facial emotion recognition), selective attention, naming, academic skills (reading/comprehension), and manual speed with right hand declined in the second evaluation relative to the initial evaluation, while visuoconstructional praxis, receptive vocabulary, working memory, and arithmetic skill improved. The patient showed a remarkable global deterioration in executive functions (planning, task flexibility, behavioral regulation, and metacognition) as revealed by parental report and clinical evaluation. MRI revealed gliosis from the head to tail of the hippocampus and thinning of parahippocampal gyri. CONCLUSIONS: In a clinical case of CCHS, serial evaluation revealed deterioration of executive functions and social cognition over a 3-year interval. These changes corresponded to hippocampal damage as revealed in MRI, which may have affected social cognition through its role in the default mode network. Serial neuropsychological assessment is clinically useful in managing the needs of these patients.

7 Article Impact of obstructive sleep apnea on cardiovascular outcomes in patients with acute symptomatic pulmonary embolism: Rationale and methodology for the POPE study. 2017

Mañas, Eva / Barbero, Esther / Chiluiza, Diana / García, Aldara / Morillo, Raquel / Barrios, Deisy / Martínez-García, Miguel Ángel / Albalat, Alicia / Cano, Irene / Jiménez, David / Anonymous4920930. ·Respiratory Department, Hospital Ramón y Cajal, and Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain. · Respiratory Department, Hospital La Fe, Valencia, Spain. · Respiratory Department, Hospital de Getafe, Madrid, Spain. ·Clin Cardiol · Pubmed #29247523.

ABSTRACT: In normotensive patients with acute symptomatic pulmonary embolism (PE), the effect of undiagnosed obstructive sleep apnea (OSA) on cardiovascular (CV) outcomes lacks clarity. The Prognostic Significance of Obstructive Sleep Apnea in Patients With Acute Symptomatic Pulmonary Embolism (POPE) study is a multicenter, observational study designed to prospectively assess the prognostic significance of concomitant OSA in hemodynamically stable outpatients with acute symptomatic PE. Adult patients with acute stable PE are eligible. Recruited patients undergo an overnight sleep study using a level III portable diagnostic device within 7 days (and preferably within 48 hours) of diagnosis of PE. The sleep tracings are analyzed by a certified sleep technologist and audited by a sleep physician, both of whom are blinded to other study data. The patients are divided into 2 groups based on apnea-hypopnea index (AHI): OSA (AHI ≥15) and non-OSA (AHI <15) groups. The study uses a composite of PE-related death, CV death, clinical deterioration requiring an escalation of treatment, or nonfatal CV events (recurrent venous thromboembolism, acute myocardial infarction, or stroke) within 30 days after the diagnosis of PE as the primary outcome. The projected sample size of 225 patients will provide 80% power to test the hypothesis that OSA will increase the primary outcome from 7% in the non-OSA group to 20% in the OSA group, with α ≤0.05. The trial results will be important to understand the burden and CV effects of OSA in PE patients.

8 Article Prevalence of acromegaly in patients with symptoms of sleep apnea. 2017

Sesmilo, Gemma / Resmini, Eugenia / Sambo, Marcel / Blanco, Concepción / Calvo, Fernando / Pazos, Fernando / Fernández-Catalina, Pablo / Martínez de Icaya, Purificación / Páramo, Concepción / Fajardo, Carmen / Marazuela, Mónica / Álvarez-Escolá, Cristina / Díez, Juan Jose / Perea, Verónica / Anonymous7060919. ·Servicio de endocrinología, Hospital Quirón-Dexeus/Clínica del Sueño Estivill, Barcelona, Spain. · IIB- Sant Pau y Servicio de Endocrinología, Departamento de Medicina, Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. · Servicio de endocrinología, Hospital Universitario Gregorio Marañón, Madrid, Spain. · Servicio de endocrinología, Hospital Universitario Príncipe de Asturias, Madrid, Spain. · Servicio de endocrinología, Hospital Clínico Universitario Lozano-Blesa, Zaragoza, Spain. · Servicio de endocrinología, Hospital Universitario Marqués de Valdecilla, Santander, Spain. · Servicio de endocrinología, Complexo Hospitalario de Pontevedra, Pontevedra, Spain. · Servicio de endocrinología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain. · Servicio de endocrinología, Complexo Hospitalario Universitario De Vigo, Vigo, Spain. · Servicio de endocrinología, Hospital Universitario de la Ribera, Alzira, Spain. · Servicio de endocrinología, Hospital de La Princesa, Madrid, Spain. · Servicio de endocrinología, Hospital Universitario la Paz, Madrid, Spain. · Servicio de endocrinología, Hospital Universitario Ramón y Cajal, Madrid, Spain. ·PLoS One · Pubmed #28898247.

ABSTRACT: Acromegaly is a rare disease with nonspecific symptoms with acral enlargement being almost universally present at diagnosis. The estimated prevalence is 40-125 cases/million but targeted universal screening studies have found a higher prevalence (about 10 fold). The aim of the ACROSAHS study was to investigate the prevalence of acromegaly and acromegaly comorbidities in patients with sleep apnea symptoms and acral enlargement. ACROSAHS was a Spanish prospective non-interventional epidemiological study in 13 Hospital sleep referral units. Facial and acral enlargement symptoms including: ring size and shoe size increase, tongue, lips and jaws enlargement, paresthesia or carpal tunnel syndrome and widening of tooth spaces, as well as other typical acromegaly comorbidities were recorded with a self-administered questionnaire of patients who attended a first visit for sleep apnea symptoms between 09/2013 and 07/2014. Serum insulin-like growth factor type 1 (IGF1) was measured in patients with ≥1 acral symptom to determine the prevalence of acromegaly. Of the 1557 patients enrolled, 1477 with complete data (72% male) were analyzed. 530 patients (36%) reported at least 1 acral enlargement symptom and were tested for IGF-1, 41 were above range, persisted in 7, and among those, 2 cases of acromegaly were diagnosed (prevalence of at least 1.35 cases/1000). Overall, 1019 patients (69%) had ≥2 acromegaly symptoms and should have been screened according to guidelines; moreover 373 patients (25%) had ≥1 symptom of acral enlargement plus ≥3 other acromegaly symptoms. In conclusion, in patients with sleep apnea symptoms and acral enlargement, we found an acromegaly prevalence of at least 1.35 cases per 1000 and a high prevalence of typical acromegaly symptoms. It is important that sleep specialists are aware of acromegaly symptoms to aid with acromegaly diagnosis.

9 Article Effect of continuous positive airway pressure on blood pressure and metabolic profile in women with sleep apnoea. 2017

Campos-Rodriguez, Francisco / Gonzalez-Martinez, Monica / Sanchez-Armengol, Angeles / Jurado-Gamez, Bernabe / Cordero-Guevara, Jose / Reyes-Nuñez, Nuria / Troncoso, Maria F / Abad-Fernandez, Araceli / Teran-Santos, Joaquin / Caballero-Rodriguez, Julian / Martin-Romero, Mercedes / Encabo-Motiño, Ana / Sacristan-Bou, Lirios / Navarro-Esteva, Javier / Somoza-Gonzalez, Maria / Masa, Juan F / Sanchez-Quiroga, Maria A / Jara-Chinarro, Beatriz / Orosa-Bertol, Belen / Martinez-Garcia, Miguel A / Anonymous5850915. ·Respiratory Dept, Hospital Universitario de Valme, Sevilla, Spain fracamrod@gmail.com. · Respiratory Dept, Hospital Universitario Marques de Valdecilla, Santander, Spain. · Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Sevilla, Spain. · Dept of Respiratory Medicine, Reina Sofia University Hospital, Institute of Biomedical Research Maimonides (IMIBIC), University of Cordoba, Spain. · Gerencia de Atención Primaria de Burgos, Burgos, Spain. · Respiratory Dept, Hospital Universitario de Valme, Sevilla, Spain. · Respiratory Dept, Fundación Jimenez Diaz, Madrid, Spain. · Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · Respiratory Dept, Hospital Universitario de Getafe, Madrid, Spain. · Respiratory Dept, Hospital Universitario de Burgos, Burgos, Spain. · Respiratory Dept, Hospital Morales Meseguer, Murcia, Spain. · Respiratory Dept, Hospital Universitario Virgen de la Victoria, Malaga, Spain. · Respiratory Dept, Hospital Severo Ochoa, Madrid, Spain. · Respiratory Dept, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain. · Respiratory Dept, Hospital Dr Negrin, Gran Canaria, Spain. · Respiratory Dept, Consorcio Sanitario de Terrassa, Barcelona, Spain. · Respiratory Dept, Hospital San Pedro de Alcantara, Caceres, Spain. · Respiratory Dept, Hospital Virgen del Puerto, Caceres, Spain. · Respiratory Dept, Hospital Puerta de Hierro, Madrid, Spain. · Respiratory Dept, Hospital Dr Peset, Valencia, Spain. · Respiratory Dept, Hospital Universitario y Politecnico La Fe, Valencia, Spain. ·Eur Respir J · Pubmed #28798089.

ABSTRACT: Continuous positive airway pressure (CPAP) reduces blood pressure levels in hypertensive patients with obstructive sleep apnoea (OSA). However, the role of CPAP in blood pressure and the metabolic profile in women has not yet been assessed. In this study we investigated the effect of CPAP on blood pressure levels and the glucose and lipid profile in women with moderate-to-severe OSA.A multicentre, open-label, randomised controlled trial was conducted in 307 women diagnosed with moderate-to-severe OSA (apnoea-hypopnoea index ≥15 events·h

10 Article Maxillomandibular advancement as the initial treatment of obstructive sleep apnoea: Is the mandibular occlusal plane the key? 2017

Rubio-Bueno, P / Landete, P / Ardanza, B / Vázquez, L / Soriano, J B / Wix, R / Capote, A / Zamora, E / Ancochea, J / Naval-Gías, L. ·University Hospital NISA Pardo de Aravaca, Madrid, Spain; Oral and Maxillofacial Department, Pneumology Department, Neurophysiology Department, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Autónoma University, Madrid, Spain. Electronic address: maxilofacial@gmail.com. · Oral and Maxillofacial Department, Pneumology Department, Neurophysiology Department, Instituto de Investigación Hospital Universitario de la Princesa (IISP), Autónoma University, Madrid, Spain. · University Hospital NISA Pardo de Aravaca, Madrid, Spain. ·Int J Oral Maxillofac Surg · Pubmed #28760319.

ABSTRACT: Maxillomandibular advancement (MMA) can be effective for managing obstructive sleep apnoea (OSA); however, limited information is available on the predictor surgical variables. This study investigated whether normalization of the mandibular occlusal plane (MOP) was a determinant factor in curing OSA. Patients with moderate or severe OSA who underwent MMA were evaluated by preoperative and postoperative three-dimensional (3D) scans and polysomnograms. The postoperative value of MOP and the magnitude of skeletal advancement were the predictor variables; change in the apnoea-hypopnoea index (AHI) was the main outcome variable. Thirty-four subjects with a mean age of 41±14years and 58,8% female were analysed. The Epworth Sleepiness Scale (ESS) was 17.4±5.4 and AHI was 38.3±10.7 per hour before surgery. Postoperative AHI was 6.5±4.3 per hour (P<0.001) with 52.94% of the patients considered as cured, and 47.06% suffering from a mild residual OSA with ESS 0.8±1.4 (P<0.001). 3D changes revealed a volume increase of 106.3±38.8%. The mandible was advanced 10.4±3.9mm and maxilla 4.9±3.2mm. MOP postoperative value was concluded to be the best predictor variable. Treatment planning should include MOP normalization and a mandibular advancement between 6 and 10mm. The maxillary advancement would depend on the desired aesthetic changes and final occlusion.

11 Article Monocytes inhibit NK activity 2017

Hernández-Jiménez, Enrique / Cubillos-Zapata, Carolina / Toledano, Victor / Pérez de Diego, Rebeca / Fernández-Navarro, Isabel / Casitas, Raquel / Carpio, Carlos / Casas-Martín, Jose / Valentín, Jaime / Varela-Serrano, Anibal / Avendaño-Ortiz, Jose / Alvarez, Enrique / Aguirre, Luis A / Pérez-Martínez, Antonio / De Miguel, Maria P / Belda-Iniesta, Cristobal / García-Río, Francisco / López-Collazo, Eduardo. ·The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain. · CIBER of Respiratory Diseases (CIBERES), Madrid, Spain. · These authors contributed equally to this work. · Respiratory Diseases Group, IdiPAZ and Respiratory Service of La Paz University Hospital, Madrid, Spain. · EMPIREO, Madrid, Spain. · Cell Engineering Laboratory, La Paz University Hospital Health Research Institute, IdiPAZ, Madrid, Spain. · Research Foundation HM Hospitals, Madrid, Spain. · The Innate Immune Response Group, IdiPAZ, La Paz University Hospital, Madrid, Spain elopezc@salud.madrid.org. ·Eur Respir J · Pubmed #28619958.

ABSTRACT: Obstructive sleep apnoea (OSA) is associated with cancer incidence and mortality. The contribution of the immune system appears to be crucial; however, the potential role of monocytes and natural killer (NK) cells remains unclear.Quantitative reverse transcriptase PCR, flow cytometry and

12 Article [Prevalence of sleep apnea disorders among high-risk patients included in a cardiac rehabilitation program]. 2017

Alegría-Barrero, Eduardo / Blázquez, Marco A / Ruiz-García, Juan / Sánchez-Rodríguez, Cristina / Abad, Irene / Alonso, Soledad. ·Servicio de Cardiología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España. Electronic address: eduar.alegria@gmail.com. · Servicio de Cardiología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España. · Servicio de Cardiología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, España. · Rehabilitación Cardiaca, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España. · Servicio de Neumología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España. ·Arch Cardiol Mex · Pubmed #27956340.

ABSTRACT: -- No abstract --

13 Article [Spanish patients with central hypoventilation syndrome included in the European Registry. The 2015 data]. 2017

García Teresa, María Angeles / Porto Abal, Raquel / Rodríguez Torres, Silvia / García Urabayen, Diego / García Martínez, Silvia / Trang, Ha / Campos Barros, Angel / Anonymous13900873 / Llorente de la Fuente, Ana / Hernández González, Arturo / Bustinza Arriortua, Amaya / de la Cruz Moreno, Jesús / Pons Odena, Martí / Ventura Faci, Purificación / Rubio Ortega, Laura / Pérez Ruiz, Estela / Aguilar Fernández, Antonio / Pérez Ocón, Amaya / Osona, Borja / Delgado Pecellin, Isabel / Arroyo Carrera, Ignacio / Sayas Catalán, Javier / González Salas, Elvira / de Vicente, Carlos Martin. ·Cuidados Intensivos Pediátricos, Hospital Niño Jesús, Madrid, España. Electronic address: angelesgarciateresa@gmail.com. · Pediatría, CS Villalva Pueblo, Madrid, España. · Neumología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Barcelona, España. · Cuidados Intensivos Pediátricos, Hospital de Cruces, Bilbao, Vizcaya, España. · Hospitalización Domiciliaria Pediátrica, Hospital de la Arrixaca, Murcia, España. · Centro de Referencia Francés de Hipoventilación Central, Hospital Robert Debré, Consorcio Europeo del Síndrome de Hipoventilación Central, París, Francia. · Instituto de Genética Médica y Molecular, IdiPAz, Hospital Universitario La Paz, CIBER de Enfermedades Raras, ISCIII, Madrid, España. · Cuidados Intensivos Pediátricos, Hospital Doce de Octubre, Madrid, España. · Cuidados Intensivos Pediátricos, Hospital Puerta del Mar, Cádiz, España. · Cuidados Intensivos Pediátricos, Hospital Gregorio Marañón, Madrid, España. · Pediatría, Hospital Universitario Materno Infantil, Jaén, España. · Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, España. · Neonatología, Hospital Lozano Blesa, Zaragoza, España. · Hospitalización a Domicilio Pediátrica, Hospital General Universitario, Alicante, España. · Neumología Infantil, Hospital Carlos Haya, Málaga, España. · Neumología Pediátrica, Hospital Materno Infantil, Las Palmas, España. · Cuidados Intensivos Pediátricos, Complejo Hospitalario de Navarra, Pamplona, Navarra, España. · Neumología Pediátrica, Hospital Son Espases, Palma de Mallorca, Islas Baleares, España. · Neumología Pediátrica, Hospital Virgen del Rocío, Sevilla, España. · Neonatología, Hospital San Pedro de Alcántara, Cáceres, España. · Neumología, Hospital Doce de Octubre, Madrid, España. · Cuidados Intensivos Pediátricos, Hospital Universitario de Salamanca, Salamanca, España. · Neumología Pediátrica, Hospital Miguel Servet, Zaragoza, España. ·An Pediatr (Barc) · Pubmed #27377324.

ABSTRACT: INTRODUCTION: Congenital Central Hypoventilation Syndrome (CCHS) is a very rare genetic disease. In 2012 the European Central Hypoventilation Syndrome (EuCHS) Consortium created an online patient registry in order to improve care. AIM: To determine the characteristics and outcomes of Spanish patients with CCHS, and detect clinical areas for improvement. MATERIALS AND METHOD: An assessment was made on the data from Spanish patients in the European Registry, updated on December 2015. RESULTS: The Registry contained 38 patients, born between 1987 and 2013, in 18 hospitals. Thirteen (34.2%) were older than 18 years. Three patients had died. Genetic analysis identified PHOX2B mutations in 32 (86.5%) out of 37 patients assessed. The 20/25, 20/26 and 20/27 polyalanine repeat mutations (PARMs) represented 84.3% of all mutations. Longer PARMs had more, as well as more severe, autonomic dysfunctions. Eye diseases were present in 47%, with 16% having Hirschsprung disease, 13% with hypoglycaemia, and 5% with tumours. Thirty patients (79%) required ventilation from the neonatal period onwards, and 8 (21%) later on in life (late onset/presentation). Eight children (21%) were using mask ventilation at the first home discharge. Five of them were infants with neonatal onset, two of them, both having a severe mutation, were switched to tracheostomy after cardiorespiratory arrest at home. Approximately one-third (34.3%) of patients were de-cannulated and switched to mask ventilation at a mean age of 13.7 years. Educational reinforcement was required in 29.4% of children attending school. CONCLUSION: The implementation of the EuCHS Registry in Spain has identified some relevant issues for optimising healthcare, such as the importance of genetic study for diagnosis and assessment of severity, the high frequency of eye disease and educational reinforcement, as well as some limitations in ventilatory techniques.

14 Article The Effect of Supplemental Oxygen in Obesity Hypoventilation Syndrome. 2016

Masa, Juan F / Corral, Jaime / Romero, Auxiliadora / Caballero, Candela / Terán-Santos, Joaquin / Alonso-Álvarez, Maria L / Gomez-Garcia, Teresa / González, Mónica / López-Martínez, Soledad / De Lucas, Pilar / Marin, José M / Marti, Sergi / Díaz-Cambriles, Trinidad / Chiner, Eusebi / Merchan, Miguel / Egea, Carlos / Obeso, Ana / Mokhlesi, Babak / Anonymous5290879. ·San Pedro de Alcántara Hospital, Cáceres, Spain. · CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Virgen del Rocío Hospital, Sevilla, Spain. · University Hospital, Burgos, Spain. · IIS Fundación Jiménez Díaz, Madrid, Spain. · Valdecilla Hospital, Santander, Spain. · Gregorio Marañon Hospital, Madrid, Spain. · Miguel Servet Hospital, Zaragoza, Spain. · Valld'Hebron Hospital, Barcelona, Spain. · Doce de Octubre Hospital, Madrid, Spain. · San Juan Hospital, Alicante, Spain. · Sleep Unit, Respiratory Department, Alava University Hospital IRB, Vitoria, Spain. · Department of Physiology, University of Valladolid, Spain. · Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL. ·J Clin Sleep Med · Pubmed #27568890.

ABSTRACT: STUDY OBJECTIVES: Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). However, there is a paucity of data regarding its efficacy and safety. The objective of this study was to assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS. METHODS: In this RESULTS: In the noninvasive ventilation group, supplemental oxygen reduced systolic blood pressure although this could be also explained by a reduction in body weight experienced in this group. In the continuous positive airway pressure group, supplemental oxygen increased the frequency of morning confusion. In the lifestyle modification group, supplemental oxygen increased compensatory metabolic alkalosis and decreased the apnea-hypopnea index during sleep. Oxygen therapy was not associated with an increase in hospital resource utilization in any of the groups. CONCLUSIONS: After 2 mo of follow-up, chronic oxygen therapy produced marginal changes that were insufficient to consider it, globally, as beneficial or deleterious. Because supplemental oxygen therapy did not increase hospital resource utilization, we recommend prescribing oxygen therapy to patients with OHS who meet criteria with close monitoring. Long-term studies examining outcomes such as incident cardiovascular morbidity and mortality are necessary. CLINICAL TRIALS REGISTRATION: Clinicaltrial.gov, ID: NCT01405976.

15 Article Noninvasive ventilation for severely acidotic patients in respiratory intermediate care units : Precision medicine in intermediate care units. 2016

Masa, Juan F / Utrabo, Isabel / Gomez de Terreros, Javier / Aburto, Myriam / Esteban, Cristóbal / Prats, Enric / Núñez, Belén / Ortega-González, Ángel / Jara-Palomares, Luis / Martin-Vicente, M Jesus / Farrero, Eva / Binimelis, Alicia / Sala, Ernest / Serrano-Rebollo, José C / Barrot, Emilia / Sánchez-Oro-Gomez, Raquel / Fernández-Álvarez, Ramón / Rodríguez-Jerez, Francisco / Sayas, Javier / Benavides, Pedro / Català, Raquel / Rivas, Francisco J / Egea, Carlos J / Antón, Antonio / Peñacoba, Patricia / Santiago-Recuerda, Ana / Gómez-Mendieta, M A / Méndez, Lidia / Cebrian, José J / Piña, Juan A / Zamora, Enrique / Segrelles, Gonzalo. ·San Pedro de Alcántara Hospital, C/Rafael Alberti 12, 10005, Cáceres, Spain. fmasa@separ.es. · CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. fmasa@separ.es. · San Pedro de Alcántara Hospital, C/Rafael Alberti 12, 10005, Cáceres, Spain. · CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · Galdakao-Usansolo Hospital, Bilbao, Spain. · Belvitge Hospital, Barcelona, Spain. · Son Espases Hospital, Palma de Mallorca, Spain. · Nuestra Señora del Prado Hospital, Talavera de la Reina, Toledo, Spain. · Virgen del Rocío Hospital, Sevilla, Spain. · Central de Asturias Hospital, Oviedo, Spain. · Doce de Octubre Hospital, Madrid, Spain. · "Sant Joan" University Hospital, Universitat Rovira i Virgili, IISPV, Reus, Tarragona, Spain. · Txaguritxu Hospital, Vitoria, Spain. · Sant Pau Hospital, Barcelona, Spain. · La Paz Hospital, Madrid, Spain. · Universitario Lucus Augusti Hospital, Lugo, Spain. · Costa del Sol Hospital, Málaga, Spain. · La Princesa Hospital, Madrid, Spain. ·BMC Pulm Med · Pubmed #27387544.

ABSTRACT: BACKGROUND: Severe acidosis can cause noninvasive ventilation (NIV) failure in chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure (AHRF). NIV is therefore contraindicated outside of intensive care units (ICUs) in these patients. Less is known about NIV failure in patients with acute cardiogenic pulmonary edema (ACPE) and obesity hypoventilation syndrome (OHS). Therefore, the objective of the present study was to compare NIV failure rates between patients with severe and non-severe acidosis admitted to a respiratory intermediate care unit (RICU) with AHRF resulting from ACPE, COPD or OHS. METHODS: We prospectively included acidotic patients admitted to seven RICUs, where they were provided NIV as an initial ventilatory support measure. The clinical characteristics, pH evolutions, hospitalization or RICU stay durations and NIV failure rates were compared between patients with a pH ≥ 7.25 and a pH < 7.25. Logistic regression analysis was performed to determine the independent risk factors contributing to NIV failure. RESULTS: We included 969 patients (240 with ACPE, 540 with COPD and 189 with OHS). The baseline rates of severe acidosis were similar among the groups (45 % in the ACPE group, 41 % in the COPD group, and 38 % in the OHS group). Most of the patients with severe acidosis had increased disease severity compared with those with non-severe acidosis: the APACHE II scores were 21 ± 7.2 and 19 ± 5.8 for the ACPE patients (p < 0.05), 20 ± 5.7 and 19 ± 5.1 for the COPD patients (p < 0.01) and 18 ± 5.9 and 17 ± 4.7 for the OHS patients, respectively (NS). The patients with severe acidosis also exhibited worse arterial blood gas parameters: the PaCO2 levels were 87 ± 22 and 70 ± 15 in the ACPE patients (p < 0.001), 87 ± 21 and 76 ± 14 in the COPD patients, and 83 ± 17 and 74 ± 14 in the OHS patients (NS)., respectively Further, the patients with severe acidosis required a longer duration to achieve pH normalization than those with non-severe acidosis (patients with a normalized pH after the first hour: ACPE, 8 % vs. 43 %, p < 0.001; COPD, 11 % vs. 43 %, p < 0.001; and OHS, 13 % vs. 51 %, p < 0.001), and they had longer RICU stays, particularly those in the COPD group (ACPE, 4 ± 3.1 vs. 3.6 ± 2.5, NS; COPD, 5.1 ± 3 vs. 3.6 ± 2.1, p < 0.001; and OHS, 4.3 ± 2.6 vs. 3.7 ± 3.2, NS). The NIV failure rates were similar between the patients with severe and non-severe acidosis in the three disease groups (ACPE, 16 % vs. 12 %; COPD, 7 % vs. 7 %; and OHS, 11 % vs. 4 %). No common predictive factor for NIV failure was identified among the groups. CONCLUSIONS: ACPE, COPD and OHS patients with AHRF and severe acidosis (pH ≤ 7.25) who are admitted to an RICU can be successfully treated with NIV in these units. These results may be used to determine precise RICU admission criteria.

16 Article Continuous Positive Airway Pressure Improves Quality of Life in Women with Obstructive Sleep Apnea. A Randomized Controlled Trial. 2016

Campos-Rodriguez, Francisco / Queipo-Corona, Carlos / Carmona-Bernal, Carmen / Jurado-Gamez, Bernabe / Cordero-Guevara, Jose / Reyes-Nuñez, Nuria / Troncoso-Acevedo, Fernanda / Abad-Fernandez, Araceli / Teran-Santos, Joaquin / Caballero-Rodriguez, Julian / Martin-Romero, Mercedes / Encabo-Motiño, Ana / Sacristan-Bou, Lirios / Navarro-Esteva, Javier / Somoza-Gonzalez, Maria / Masa, Juan F / Sanchez-Quiroga, Maria A / Jara-Chinarro, Beatriz / Orosa-Bertol, Belen / Martinez-Garcia, Miguel A / Anonymous400868. ·1 Respiratory Department, Hospital Universitario de Valme, Sevilla, Spain. · 2 Respiratory Department, Hospital Universitario Marques de Valdecilla, Santander, Spain. · 3 Medical-Surgical Unit of Respiratory Diseases, Virgen del Rocio University Hospital, Sevilla, Spain. · 4 Department of Respiratory Medicine, Reina Sofia University Hospital, Institute of Biomedical Research Maimonides (IMIBIC), University of Cordoba, Cordoba, Spain. · 5 Gerencia de Atención Primaria de Burgos, Burgos, Spain. · 6 Respiratory Department, Fundación Jimenez Diaz, Madrid, Spain. · 7 Respiratory Department, Hospital Universitario de Getafe, Madrid, Spain. · 8 Respiratory Department, Hospital Universitario de Burgos, Burgos, Spain. · 9 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. · 10 Respiratory Department, Hospital Morales Meseguer, Murcia, Spain. · 11 Respiratory Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain. · 12 Respiratory Department, Hospital Severo Ochoa, Madrid, Spain. · 13 Respiratory Department, Hospital General de Tomelloso, Ciudad Real, Spain. · 14 Respiratory Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain. · 15 Respiratory Department, Consorcio Sanitario de Terrassa, Barcelona, Spain. · 16 Respiratory Department, Hospital San Pedro de Alcantara, Caceres, Spain. · 17 Respiratory Department, Hospital Virgen del Puerto, Caceres, Spain. · 18 Respiratory Department, Hospital Puerta de Hierro, Madrid, Spain. · 19 Respiratory Department, Hospital Universitario Doctor Peset, Valencia, Spain; and. · 20 Respiratory Department, Hospital Universitario y Politecnico La Fe, Valencia, Spain. ·Am J Respir Crit Care Med · Pubmed #27181196.

ABSTRACT: RATIONALE: Continuous positive airway pressure (CPAP) is the treatment of choice in patients with symptomatic obstructive sleep apnea (OSA). CPAP treatment improves quality of life (QoL) in men with OSA, but its role in women has not yet been assessed. OBJECTIVES: To investigate the effect of CPAP on QoL in women with moderate to severe OSA. METHODS: We conducted a multicenter, open-label randomized controlled trial in 307 consecutive women diagnosed with moderate to severe OSA (apnea-hypopnea index, ≥15) in 19 Spanish sleep units. Women were randomized to receive effective CPAP therapy (n = 151) or conservative treatment (n = 156) for 3 months. The primary endpoint was the change in QoL based on the Quebec Sleep Questionnaire. Secondary endpoints included changes in daytime sleepiness, mood state, anxiety, and depression. Data were analyzed on an intention-to-treat basis with adjustment for baseline values and other relevant clinical variables. MEASUREMENTS AND MAIN RESULTS: The women in the study had a mean (SD) age of 57.1 (10.1) years and a mean (SD) Epworth Sleepiness Scale score of 9.8 (4.4), and 77.5% were postmenopausal. Compared with the control group, the CPAP group achieved a significantly greater improvement in all QoL domains of the Quebec Sleep Questionnaire (adjusted treatment effect between 0.53 and 1.33; P < 0.001 for all domains), daytime sleepiness (-2.92; P < 0.001), mood state (-4.24; P  = 0.012), anxiety (-0.89; P = 0.014), depression (-0.85; P = 0.016), and the physical component summary of the 12-item Short Form Health Survey (2.78; P = 0.003). CONCLUSIONS: In women with moderate or severe OSA, 3 months of CPAP therapy improved QoL, mood state, anxiety and depressive symptoms, and daytime sleepiness compared with conservative treatment. Clinical trial registered with www.clinicaltrials.gov (NCT02047071).

17 Article Cost-effectiveness of Continuous Positive Airway Pressure Treatment in Moderate-Severe Obstructive Sleep Apnea Syndrome. 2016

Català, Raquel / Villoro, Renata / Merino, María / Sangenís, Sandra / Colomés, Lluís / Hernández Flix, Salvador / Pérez de Llano, Luis A. ·Unidad del Sueño, Sección de Neumología, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Reus, Tarragona, España. Electronic address: raqcatala@hotmail.com. · Instituto Max Weber, Madrid, España. · Unidad del Sueño, Sección de Neumología, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Reus, Tarragona, España. · Innovació i Docència, Grup SAGESSA-GINSA, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Reus, Tarragona, España. · Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España. ·Arch Bronconeumol · Pubmed #26993090.

ABSTRACT: INTRODUCTION: The socioeconomic impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) is considerable. The aim of this study was to evaluate the cost-effectiveness of treating OSAHS with continuous positive airway pressure (CPAP) and the impact of CPAP compliance. METHODS: This was a retrospective, case-crossover study of 373 patients with OSAHS receiving CPAP. We compared changes in costs, Epworth score and health-related quality of life (EQ-5D questionnaires) between the year before treatment and the year after treatment. The incremental cost-effectiveness ratio (ICER) for the first year of treatment was estimated, and projections were made for the second year, using different effectiveness and cost scenarios. RESULTS: The visual analog scale score for the EQ-5D questionnaire increased by 5 points and the Epworth score fell by 10 points during the year of CPAP treatment. Mean gain in quality-adjusted life years (QALY) was 0.05 per patient per year (P<.001): 0.07 among compliers and -0.04 among non-compliers. ICER was €51,147/QALY during the first year of CPAP treatment and €1,544/QALY during the second year. CONCLUSION: CPAP treatment in patients with moderate-severe OSAHS improves the quality of life of compliant patients, and is cost-effective as of the second year.

18 Article Effect of Continuous Positive Airway Pressure on Glycemic Control in Patients with Obstructive Sleep Apnea and Type 2 Diabetes. A Randomized Clinical Trial. 2016

Martínez-Cerón, Elisabet / Barquiel, Beatriz / Bezos, Ana-Maria / Casitas, Raquel / Galera, Raúl / García-Benito, Cristina / Hernanz, Angel / Alonso-Fernández, Alberto / Garcia-Rio, Francisco. ·1 Servicio de Neumología. · 2 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain. · 3 Servicio de Endocrinología, and. · 4 Centro de Salud José Marvá, Madrid, Spain. · 5 Centro de Salud El Puerto, Coslada, Madrid, Spain. · 6 Servicio de Bioquímica, Hospital Universitario La Paz, Madrid, Spain. · 7 Servicio de Neumología, Hospital Universitario Son Espases, Palma de Mallorca, Spain; and. · 8 Universidad Autónoma de Madrid, Madrid, Spain. ·Am J Respir Crit Care Med · Pubmed #26910598.

ABSTRACT: RATIONALE: Obstructive sleep apnea (OSA) is a risk factor for type 2 diabetes that adversely impacts glycemic control. However, there is little evidence about the effect of continuous positive airway pressure (CPAP) on glycemic control in patients with diabetes. OBJECTIVES: To assess the effect of CPAP on glycated hemoglobin (HbA1c) levels in patients with suboptimally controlled type 2 diabetes and OSA, and to identify its determinants. METHODS: In a 6-month, open-label, parallel, and randomized clinical trial, 50 patients with OSA and type 2 diabetes and two HbA1c levels equal to or exceeding 6.5% were randomized to CPAP (n = 26) or no CPAP (control; n = 24), while their usual medication for diabetes remained unchanged. MEASUREMENTS AND MAIN RESULTS: HbA1c levels, Homeostasis Model Assessment and Qualitative Insulin Sensitivity Check Index scores, systemic biomarkers, and health-related quality of life were measured at 3 and 6 months. After 6 months, the CPAP group achieved a greater decrease in HbA1c levels compared with the control group. Insulin resistance and sensitivity measurements (in noninsulin users) and serum levels of IL-1β, IL-6, and adiponectin also improved in the CPAP group compared with the control group after 6 months. In patients treated with CPAP, mean nocturnal oxygen saturation and baseline IL-1β were independently related to the 6-month change in HbA1c levels (r(2) = 0.510, P = 0.002). CONCLUSIONS: Among patients with suboptimally controlled type 2 diabetes and OSA, CPAP treatment for 6 months resulted in improved glycemic control and insulin resistance compared with results for a control group. Clinical trial registered with www.clinicaltrials.gov (NCT01801150).

19 Article Reviewing the connection between speech and obstructive sleep apnea. 2016

Espinoza-Cuadros, Fernando / Fernández-Pozo, Rubén / Toledano, Doroteo T / Alcázar-Ramírez, José D / López-Gonzalo, Eduardo / Hernández-Gómez, Luis A. ·GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, Madrid, Spain. fernando@gaps.ssr.upm.es. · GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, Madrid, Spain. ruben@gaps.ssr.upm.es. · ATVS Biometric Recognition Group, Universidad Autónoma de Madrid, Madrid, Spain. doroteo.torre@uam.es. · Respiratory Department, Sleep Unit Hospital Quirón Málaga, Málaga, Spain. jose44@separ.es. · GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, Madrid, Spain. eduardo.lopez@upm.es. · GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, Madrid, Spain. luisalfonso.hernandez@upm.es. ·Biomed Eng Online · Pubmed #26897500.

ABSTRACT: BACKGROUND: Sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). The altered UA structure or function in OSA speakers has led to hypothesize the automatic analysis of speech for OSA assessment. In this paper we critically review several approaches using speech analysis and machine learning techniques for OSA detection, and discuss the limitations that can arise when using machine learning techniques for diagnostic applications. METHODS: A large speech database including 426 male Spanish speakers suspected to suffer OSA and derived to a sleep disorders unit was used to study the clinical validity of several proposals using machine learning techniques to predict the apnea-hypopnea index (AHI) or classify individuals according to their OSA severity. AHI describes the severity of patients' condition. We first evaluate AHI prediction using state-of-the-art speaker recognition technologies: speech spectral information is modelled using supervectors or i-vectors techniques, and AHI is predicted through support vector regression (SVR). Using the same database we then critically review several OSA classification approaches previously proposed. The influence and possible interference of other clinical variables or characteristics available for our OSA population: age, height, weight, body mass index, and cervical perimeter, are also studied. RESULTS: The poor results obtained when estimating AHI using supervectors or i-vectors followed by SVR contrast with the positive results reported by previous research. This fact prompted us to a careful review of these approaches, also testing some reported results over our database. Several methodological limitations and deficiencies were detected that may have led to overoptimistic results. CONCLUSION: The methodological deficiencies observed after critically reviewing previous research can be relevant examples of potential pitfalls when using machine learning techniques for diagnostic applications. We have found two common limitations that can explain the likelihood of false discovery in previous research: (1) the use of prediction models derived from sources, such as speech, which are also correlated with other patient characteristics (age, height, sex,…) that act as confounding factors; and (2) overfitting of feature selection and validation methods when working with a high number of variables compared to the number of cases. We hope this study could not only be a useful example of relevant issues when using machine learning for medical diagnosis, but it will also help in guiding further research on the connection between speech and OSA.

20 Article [Diagnostic value of respiratory polygraphy in patients with low probability of obstructive sleep apnea syndrome]. 2016

Hernandez Voth, Ana / Mora Ortega, Gemma / Moreno Zabaleta, Raul / Montoro Zulueta, Javier / Verdugo Cartas, Maria I / Rojo Moreno-Arrones, Blas / Lores Gutierrez, Vanesa / Ramirez Prieto, María T. ·Servicio de Neumología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España. Electronic address: anahvoth@gmail.com. · Servicio de Neumología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España. ·Med Clin (Barc) · Pubmed #26726116.

ABSTRACT: INTRODUCTION AND OBJECTIVE: Polysomnography (PSG) is the gold standard technic for the diagnosis of obstructive sleep apnea syndrome (OSAS). It is an expensive, complex and not always available technic, meaning that respiratory polygraphy (RP) has become usual. Although RP is not validated in low probability patients, Spanish guidelines recommend conservative treatment in patients with negative RP. We intended to study the prevalence and severity of OSAS through PSG in a sample of patients with low probability and negative RP. MATERIAL AND METHODS: Retrospective, observational, descriptive and analytic study of low probability OSAS patients with negative RP in whom a PSG was performed. Anthropometric, clinical and sleep data were collected. RESULTS: Eighty-two patients were included. After PSG, a greater number of hypopneas (137.8±70.1 vs. 51.2±38.4 [P<.05]) and apnea hypopnea index (27.8±15.6 vs. 11.7±7.1 [P<.05]) was observed, as well as an increment in OSAS prevalence of 17%, which was 35% in severe OSAS. In mild OSAS, there was a decrement of 41%. CONCLUSION: According with the results of this study, RP significantly underestimates the prevalence and severity of OSAS in low probability patients. While it is necessary to adequately stratify the OSAS probability in order to correctly indicate diagnosis tests, we recommend performing a PSG in low probability patients with negative RP.

21 Article Formant Frequencies and Bandwidths in Relation to Clinical Variables in an Obstructive Sleep Apnea Population. 2016

Montero Benavides, Ana / Blanco Murillo, José Luis / Fernández Pozo, Rubén / Espinoza Cuadros, Fernando / Torre Toledano, Doroteo / Alcázar-Ramírez, José D / Hernández Gómez, Luis A. ·Signal, Systems and Radiocommunications Department, Universidad Politécnica de Madrid, Madrid, Spain. Electronic address: ana.montero@gaps.ssr.upm.es. · Signal, Systems and Radiocommunications Department, Universidad Politécnica de Madrid, Madrid, Spain. · ATVS Biometric Recognition Group, Universidad Autónoma de Madrid, Madrid, Spain. · Hospital Quirón, Málaga, Spain. ·J Voice · Pubmed #25795368.

ABSTRACT: OBJECTIVES: We investigated whether differences in formants and their bandwidths, previously reported comparing small sample population of healthy individuals and patients with obstructive sleep apnea (OSA), are detected on a larger population representative of a clinical practice scenario. We examine possible indirect or mediated effects of clinical variables, which may shed some light on the connection between speech and OSA. STUDY DESIGN: In a retrospective study, 241 male subjects suspected to suffer from OSA were examined. The apnea-hypopnea index (AHI) was obtained for every subject using overnight polysomnography. Furthermore, the clinical variables usually reported as predictors of OSA, body mass index (BMI), cervical perimeter, height, weight, and age, were collected. Voice samples of sustained phonations of the vowels /a/, /e/, /i/, /o/, and /u/ were recorded. METHODS: Formant frequencies F1, F2, and F3 and bandwidths BW1, BW2, and BW3 of the sustained vowels were determined using spectrographic analysis. Correlations among AHI, clinical parameters, and formants and bandwidths were determined. RESULTS: Correlations between AHI and clinical variables were stronger than those between AHI and voice features. AHI only correlates poorly with BW2 of /a/ and BW3 of /e/. A number of further weak but significant correlations have been detected between voice and clinical variables. Most of them were for height and age, with two higher values for age and F2 of /o/ and F2 of /u/. Only few very weak correlations were detected between voice and BMI, weight and cervical perimeter, wich are the clinical variables more correlated with AHI. CONCLUSIONS: No significant correlations were detected between AHI and formant frequencies and bandwidths. Correlations between voice and other clinical factors characterizing OSA are weak but highlight the importance of considering indirect or mediated effects of such clinical variables in any research on speech and OSA.

22 Article Speech Signal and Facial Image Processing for Obstructive Sleep Apnea Assessment. 2015

Espinoza-Cuadros, Fernando / Fernández-Pozo, Rubén / Toledano, Doroteo T / Alcázar-Ramírez, José D / López-Gonzalo, Eduardo / Hernández-Gómez, Luis A. ·GAPS Signal Processing Applications Group, Universidad Politécnica de Madrid, 28040 Madrid, Spain. · ATVS Biometric Recognition Group, Universidad Autónoma de Madrid, Madrid, Spain. · Respiratory Department, Sleep Unit, Hospital Quirón, Málaga, Spain. ·Comput Math Methods Med · Pubmed #26664493.

ABSTRACT: Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring breathing pauses during sleep caused by a blockage of the upper airway (UA). OSA is generally diagnosed through a costly procedure requiring an overnight stay of the patient at the hospital. This has led to proposing less costly procedures based on the analysis of patients' facial images and voice recordings to help in OSA detection and severity assessment. In this paper we investigate the use of both image and speech processing to estimate the apnea-hypopnea index, AHI (which describes the severity of the condition), over a population of 285 male Spanish subjects suspected to suffer from OSA and referred to a Sleep Disorders Unit. Photographs and voice recordings were collected in a supervised but not highly controlled way trying to test a scenario close to an OSA assessment application running on a mobile device (i.e., smartphones or tablets). Spectral information in speech utterances is modeled by a state-of-the-art low-dimensional acoustic representation, called i-vector. A set of local craniofacial features related to OSA are extracted from images after detecting facial landmarks using Active Appearance Models (AAMs). Support vector regression (SVR) is applied on facial features and i-vectors to estimate the AHI.

23 Article Male fertility is reduced by chronic intermittent hypoxia mimicking sleep apnea in mice. 2014

Torres, Marta / Laguna-Barraza, Ricardo / Dalmases, Mireia / Calle, Alexandra / Pericuesta, Eva / Montserrat, Josep M / Navajas, Daniel / Gutierrez-Adan, Alfonso / Farré, Ramon. ·CIBER Enfermedades Respiratorias, Bunyola, Spain ; Laboratori de la Son, Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. · INIA, Departamento de Reproducción Animal y Conservación de Recursos Zoogenéticos, Madrid. · CIBER Enfermedades Respiratorias, Bunyola, Spain ; Laboratori de la Son, Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain ; Institut Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain. · CIBER Enfermedades Respiratorias, Bunyola, Spain ; Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Spain ; Institut Bioenginyeria Catalunya, Barcelona, Spain. · CIBER Enfermedades Respiratorias, Bunyola, Spain ; Institut Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain ; Unitat Biofísica i Bioenginyeria, Facultat de Medicina, Universitat de Barcelona, Spain. ·Sleep · Pubmed #25364071.

ABSTRACT: STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is characterized by intermittent hypoxia and oxidative stress. However, it is unknown whether intermittent hypoxia mimicking OSA modifies male fertility. We tested the hypothesis that male fertility is reduced by chronic intermittent hypoxia mimicking OSA in a mouse model. DESIGN: Case-control comparison in a murine model. SETTING: University research laboratory. PARTICIPANTS: Eighteen F1 (C57BL/6xCBA) male mice. INTERVENTIONS: Mice were subjected to a pattern of periodic hypoxia (20 sec at 5% O2 followed by 40 sec of room air) 6 h/day for 60 days or normoxia. After this period, mice performed a mating trial to determine effective fertility by assessing the number of pregnant females and fetuses. MEASUREMENTS AND RESULTS: After euthanasia, oxidative stress in testes was assessed by measuring the expression of glutathione peroxidase 1 (Gpx1) and superoxide dismutase-1 (Sod1) by reverse-transcription polymerase chain reaction. Sperm motility was determined by Integrated Semen Analysis System (ISAS). Intermittent hypoxia significantly increased testicular oxidative stress, showing a reduction in the expression of Gpx1 and Sod1 by 38.9% and 34.4%, respectively, as compared with normoxia (P < 0.05). Progressive sperm motility was significantly reduced from 27.0 ± 6.4% in normoxia to 12.8 ± 1.8% in the intermittent hypoxia group (P = 0.04). The proportion of pregnant females and number of fetuses per mating was significantly lower in the intermittent hypoxia group (0.33 ± 0.10 and 2.45 ± 0.73, respectively) than in normoxic controls (0.72 ± 0.16 and 5.80 ± 1.24, respectively). CONCLUSIONS: These results suggest that the intermittent hypoxia associated with obstructive sleep apnea (OSA) could induce fertility reduction in male patients with this sleep breathing disorder.

24 Article Effectiveness of home single-channel nasal pressure for sleep apnea diagnosis. 2014

Masa, Juan F / Duran-Cantolla, Joaquin / Capote, Francisco / Cabello, Marta / Abad, Jorge / Garcia-Rio, Francisco / Ferrer, Antoni / Mayos, Merche / Gonzalez-Mangado, Nicolas / de la Peña, Monica / Aizpuru, Felipe / Barbe, Ferran / Montserrat, Jose M / Anonymous4480809 / Larrateguy, Luis D / de Castro, Jorge Rey / Garcia-Ledesma, Estefania / Utrabo, Isabel / Corral, Jaime / Martinez-Null, Cristina / Egea, Carlos / Cancelo, Laura / García-Díaz, Emilio / Carmona-Bernal, Carmen / Sánchez-Armengol, Angeles / Fortuna, Ana M / Miralda, Rosa M / Troncoso, Maria F / Monica, Gonzalez / Martinez-Martinez, Marian / Cantalejo, Olga / Piérola, Javier / Vigil, Laura / Embid, Cristina / Del Mar Centelles, Mireia / Prieto, Teresa Ramírez / Rojo, Blas / Vanesa, Lores. ·San Pedro de Alcantara Hospital, Caceres, Spain and CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Bio-Araba Research Institute; Alava University Hospital, Vitoria, Spain: Department of Medicine of Basque Country University, Vitoria, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Virgen del Rocio Hospital, Sevilla, Spain. · Valdecilla Hospital, Santander, Spain. · Germans Trials i Pujol Hospital, Barcelona, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · La Paz Hospital, IdiPAZ, Madrid, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Sabadell Hospital, Corporació Sanitària Parc Taulí, Institut Universitari Parc Tauli-UAB, Sabadell, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Sta Creu i Sant Pau Hospital, Barcelona, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · IIS-Fundación Jimenez Diaz, Madrid, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Son Espases University Hospital, Palma de Mallorca, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Bio-Araba Research Institute; Alava University Hospital, Vitoria, Spain. · IRBLleida, Lleida, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Clinic Hospital, Barcelona, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Centro de Medicina Respiratoria, Paraná, Argentina. · Clínica Angloamericana, Lima, Perú · San Pedro de Alcantara Hospital, Caceres, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Bio-Araba Research Institute; Alava University Hospital, Vitoria, Spain: Sleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain: CIBER de enfermedades respiratorias (CIBERES), Madrid, Spain. · Bio-Araba Research Institute; Alava University Hospital, Vitoria, Spain: Sleep Unit, Respiratory Department, Alava University Hospital, Vitoria, Spain. · IIS-Fundación Jimenez Diaz, Madrid, Spain. · Sabadell Hospital, Corporació Sanitària Parc Taulí, Institut Universitari Parc Tauli-UAB, Sabadell, Spain. · Clinic Hospital, Barcelona, Spain. · Infanta Sofía Hospital, San Sebastián de los Reyes, Madrid, Spain. · Infanta Leonor Hospital, Madrid, Spain. ·Sleep · Pubmed #25325484.

ABSTRACT: INTRODUCTION: Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis, but no cost studies have yet been carried out. Automatic scoring is simpler but generally less effective than manual scoring. OBJECTIVES: To determine the diagnostic efficacy and cost of both scorings (automatic and manual) compared with PSG, taking as a polysomnographic OSA diagnosis several apnea-hypopnea index (AHI) cutoff points. METHODS: We included suspected OSA patients in a multicenter study. They were randomized to home and hospital protocols. We constructed receiver operating characteristic (ROC) curves for both scorings. Diagnostic efficacy was explored for several HNP AHI cutoff points, and costs were calculated for equally effective alternatives. RESULTS: Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI < 15; similar curves were obtained for AHI ≥ 15. A valid HNP with manual scoring would determine the presence of OSA (or otherwise) in 90% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 74% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 61% of patients with a polysomnographic AHI ≥ 15 cutoff point. In the same way, a valid HNP with automatic scoring would determine the presence of OSA (or otherwise) in 73% of patients with a polysomnographic AHI ≥ 5 cutoff point, in 64% of patients with a polysomnographic AHI ≥ 10 cutoff point, and in 57% of patients with a polysomnographic AHI ≥ 15 cutoff point. The costs of either HNP approaches were 40% to 70% lower than those of PSG at the same level of diagnostic efficacy. Manual HNP had the lowest cost for low polysomnographic AHI levels (≥ 5 and ≥ 10), and manual and automatic scorings had similar costs for higher polysomnographic cutoff points (AHI ≥ 15) of diagnosis. CONCLUSION: Home single-channel nasal pressure (HNP) is a cheaper alternative than polysomnography for obstructive sleep apnea diagnosis. HNP with manual scoring seems to have better diagnostic accuracy and a lower cost than automatic scoring for patients with low apnea-hypopnea index (AHI) levels, although automatic scoring has similar diagnostic accuracy and cost as manual scoring for intermediate and high AHI levels. Therefore, automatic scoring can be appropriately used, although diagnostic efficacy could improve if we carried out manual scoring on patients with AHI < 15. CLINICAL TRIALS INFORMATION: Clinicaltrials.gov identifier: NCT01347398.

25 Article Fingerprinting-based metabolomic approach with LC-MS to sleep apnea and hypopnea syndrome: a pilot study. 2013

Ferrarini, Alessia / Rupérez, Francisco J / Erazo, Marcela / Martínez, Ma Paz / Villar-Álvarez, Felipe / Peces-Barba, Germán / González-Mangado, Nicolás / Troncoso, María F / Ruiz-Cabello, Jesús / Barbas, Coral. ·Center for Metabolomics and Bioanalysis (CEMBIO), Facultad de Farmacia, Universidad CEU San Pablo, Madrid, Spain. ·Electrophoresis · Pubmed #23775633.

ABSTRACT: Sleep apnea and hypopnea syndrome (SAHS) is a multicomponent disorder, with associated cardiovascular and metabolic alterations, second in order of frequency among respiratory disorders. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, which requires having the patient in hospital. In addition, a more clear classification of patients according to mild and severe presentations would be desirable. The aim of the present study was to assess the relative metabolic changes in SAHS to identify new potential biomarkers for diagnosis, able to evaluate disease severity to establish response to therapeutic interventions and outcomes. For this purpose, metabolic fingerprinting represents a valuable strategy to monitor, in a nontargeted manner, the changes that are at the base of the pathophysiological mechanism of SAHS. Plasma samples of 33 SAHS patients were collected after polysomnography and analyzed with LC coupled to MS (LC-QTOF-MS). After data treatment and statistical analysis, signals differentiating nonsevere and severe patients were detected. Putative identification of 14 statistically significant features was obtained and changes that can be related to the episodes of hypoxia/reoxygenation (inflammation) have been highlighted. Among them, the patterns of variation of platelet activating factor and lysophospholipids, together with some compounds related to differential activity of the gut microflora (bile pigments and pipecolic acid) open new lines of research that will benefit our understanding of the alterations, offering new possibilities for adequate monitoring of the stage of the disease.

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