Showing of 1 until 9 from 9 result(s)
Search for: Eduardo Borsini
INTRODUCTION: Obstructive sleep apnea syndrome (OSA) is diagnosed through polysomnography (PSG) or respiratory polygraphy (RP). Self-administered home-based RP using devices with data transmission could facilitate diagnosis in distant populations. The purpose of this work was to describe a telemedicine initiative using RP in four satellite outpatient care clinics (OCC) of Buenos Aires Hospital Británico Central (HBC). Materials and methods: OCC technicians were trained both in the use of RP. Raw signals were sent to HBC via intranet software for scoring and final report.
RESULTS: During a 24-month 499 RP were performed in 499 patients: 303 men (60.7%) with the following characteristics (mean and standard deviation): valid time for manual analysis: 392.8 min ( ± 100.1), AHI: 17.05 ( ± 16.49 and percentile 25-75 [Pt]: 5-23) ev/hour, ODI (criterion 3%): 18.05 ( ± 16.48 and Pt 25-75: 6-25) ev/hour, and time below 90% (T <90): 17.9% (±23.4 and Pt 25-75: 1-23). The distribution of diagnoses (absolute value and percentage) was: normal (66/13%), snoring (70/14%), mild (167/33.5%), moderate (110/22%), and severe (86/17.2%). Continuous positive airway pressure (CPAP) was indicated for 191 patients (38.6%). Twenty recordings (4%) were considered invalid and the RP had to be repeated.
Keywords: Respiratory polygraphy, OSA, Telemedicine
INTRODUCTION: Patients that started on Non-Invasive Ventilation (NIV) need to define several parameters selected on the basis of diurnal arterial blood gas and underlying disease. We hypothesize that respiratory polygraphy (RP) could be useful to monitor NIV. This retrospective work describes RP findings and their impact on the setting of continuous flow ventilators from patients on NIV of Intensive Care Unit (ICU).
MATERIAL AND METHODS: Patient's data on NIV from at the ICU of Hospital Británico were included in this study. RP recordings were performed in all of them. Respiratory events, such as ventilatory pattern changes, impact on oximetry or tidal volume, were observed to modify the ventilatory mode after RP.
RESULTS: The RP findings have contributes to change the ventilatory mode for one third of the patients. The mean values of expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) were not significantly different across all the population before or after RP: 8.7±0.3 vs. 8.6±0.4; p<0.88 and 18.6±0.6 vs. 17.7±0.7; p<0.26 respectively, however, half the patients presented > 2 cmH2O pressure value changes after RP.
CONCLUSIONS: RP recordings could contribute to broad range of data useful to make decisions about changes in programming and allowed to identify adverse events related to positive pressure.
Keywords: Oximetry; Noninvasive ventilation; Intensive care units; Blood gas analysis.
INTRODUCTION: Obstructive Sleep Apnea (OSA) has been associated with an elevated risk of cardiac arrhythmia. Continuous positive airway pressure (CPAP) is the selected treatment for moderate to severe OSA and could improve arrhythmias in the long term. However, the acute effect of CPAP has not been studied in detail.
METHODS: We conducted a prospective study with 25 patients with moderate to severe OSA diagnosed by home respiratory polygraphy (RP) and arrhythmia and/or pauses in 24-hour Holter ECG. We analyzed inflammatory parameters and the rate of arrhythmias/pauses after 7 days of auto-adjusting CPAP.
RESULTS: 92.5% of the patients were men with a mean age of 61.7±1.9 years. Body mass index (BMI) was 59.5±2.2 kg/m2, with a mean apnea hypopnea index (AHI) of 37.7±3.8 events/hour (ev/h), and a residual AHI (AHIr) of 5.3±0.53 ev/h. After short treatment with CPAP we observed a tendency to improvement in both the severity and number of ventricular extrasystoles (VE) (1595.0±850.3 vs. 926.4±434.5 respectively), pauses and the inflammatory parameters (CRP 3.9±3.1 vs. 1.7±1.2, glycemia 131.4±11.6 vs. 121.9±9.8, HOMA 24.4±3.1 vs. 21.7±2.8, insulin 7.6±1.4 vs. 7.2±1.2 (p>0.5).
CONCLUSION: We didn´t find significant changes in pauses, VE and inflammatory parameters with CPAP short therapy in CPAP naive patients recently diagnosed with OSA.
Keywords: Arrhythmias, Cardiac; Blood Chemical Analysis; Sleep Apnea, Obstructive.
OBJECTIVE: To establish the prevalence of positional (PP) OSA patients using self-administered home-based respiratory polygraphy (RP).
MATERIALS AND METHODS: 52 month retrospective study based on RP records.
RESULTS: 200 PR records: 70.5% men 29.5% women. 76% were diagnosed with OSA and 54.6% with PP OSA. There were no significant differences in Epworth Sleepiness Scale, apnea hypopnea index and oxygen desaturation index. PP OSA patients were younger, had a lower BMI (30.3±0.9 vs. 35.3±1.2) (p<0.0001), and the time they spent with oxygen saturation <90% (T<90) was lower (8.8 vs. 28.7±6.7, p=0.0038). The PP OSA group spent 43% of total recording time in the supine position.
CONCLUSIONS: The prevalence of PP OSA patients studied with RP is similar to the one described by sleep laboratories. They have lower BMI, present mostly mild OSA with less desaturation, and are less likely to receive CPAP therapy.
Keywords: Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Supine Position.
According to recent reports, sleep disorders affect 30% of the adult population and 5-10% of children. Obstructive Sleep Apnea Hypopnea Syndrome (OSA) has a considerable epidemiological impact and demand for consultation is growing in our community. Therefore, it is necessary to know the principles of interpretation of diagnostic methods. A suspicion of OSA requires confirmation. According to the guidelines of the Argentine Association of Respiratory Medicine, polysomnography (PSG) is the gold standard for OSA diagnosis, while home sleep testing (HST) can be accepted as a comparatively effective method depending on the clinical situation of the patient. This article questions the use of AHI (apnea-hypopnea index) as the only measurement needed to diagnose OSA and assess its severity. In fact, it is surprising that, despite the large mass of data analyzed during sleep studies, current practices only focus on AHI. More than four decades have passed since OSA was first described. Our tendency to oversimplify complex conditions may prevent us from gaining a deeper and more thorough understanding of OSA. The development and validation of OSA severity scoring systems based on multiple parameters is still a pending issue.
Keywords: Sleep Apnea Syndromes; Severity of Illness Index; Sleep Disorder.
Introduction:The most effective treatment for moderate to severe obstructive sleep apnea
(OSA) is continuous positive airway pressure (CPAP) but adherence may be a
limiting factor. Most compliance studies often only include patients under
CPAP treatment, neglecting the importance of access to treatment. The aim of
this study was to evaluate CPAP access and compliance in OSA patients, after
CPAP indication and titration. Discussion:A significant proportion of OSA patients with CPAP indication did not
initiate and/or eventually abandoned CPAP. Approximately only 50% of the
patients were still under treatment, with acceptable self-reported adherence
rate and clinical response, one year after the initial treatment indication.
Additional measures are necessary to increase access to CPAP and improve
Keywords: Sleep Apnea; Obstructive; Continuous Positive Airway Pressure; Compliance; Education
OBJECTIVES To evaluate patient's satisfaction, efficacy and adherence to CPAP with a
hybrid nasal mask (DW) we tested patients with OSA in unattended setting
under real-life conditions.
MATERIAL AND METHODS Prospective, comparative study using DW mask 7 days against habitual mask in patients adapted to CPAP therapy.
RESULTS We analyzed 52 patients: 35 men (67%) with IAH mean; 24.3±12.3 events/hour. At baseline mean compliance of 5.42±1.83 hours/night. After using DW mask, patients reported fewer marks, more comfort, greater partners acceptance, easier to use and was ranked higher to preventing leaks; p<0.05, and adherence (1 more hour per night, p>0.0042).Differences were not found in pressure 90th-95th percentile (9.6±9.2 cm of H2O, p<0.5), leaks (19.8±17 liters/min. p<0.37) or residual AHI (3.38±3.05 events/hour. p<0.93).
CONCLUSION In an uncontrolled non-randomized study, patients can use DW mask with similar leak level and better adherence as compared to conventional masks.
Keywords: Treatment Adherence and Compliance; Continuous Positive Airway Pressure; Monitoring; Sleep Apnea Syndromes.