Joaquín Durán

Hospital de Txagorritxu, Vitoria, Basque Country, Spain

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Publications (16)84.11 Total impact

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    ABSTRACT: Background: Vitamin D insufficiency and high levels of parathyroid hormone (PTH) appear to be emerging risk factors for metabolic syndrome (MS), diabetes and cardiovascular disease, conditions that occur frequently in patients with obstructive sleep apnea syndrome (OSAS). Objectives: This study examined whether serum concentrations of 25-hydroxyvitamin D [25(OH)D] and PTH were associated with the presence of MS, diabetes and hypertension among an OSAS population. Methods: A total of 826 patients (635 men and 191 women) with newly diagnosed OSAS were studied. The occurrence of the MS was analyzed according to the National Cholesterol Education Program Adult Treatment Panel III clinical criteria. Serum levels of 25(OH)D, PTH, glucose, triglycerides, cholesterol, HDL cholesterol, creatinine and uric acid were determined. Results: In 55.3% of the men and in 63.2% of the women, the serum 25(OH)D level was less than 30 ng/ml (insufficient status). After adjusting for age, sex and seasonality, there was a significant trend of decreasing odds for diabetes [odds ratio (OR) 0.55, 95% confidence interval (CI) 0.33-0.94, p(trend) = 0.038] and MS (OR 0.34, 95% CI 0.21-0.56, p(trend) < 0.001) with increasing vitamin D levels. Higher PTH levels were associated with a higher prevalence of obesity (OR 2.05, 95% CI 1.06-3.09, p(trend )< 0.001) and hypertension (OR 1.83, 95% CI 1.01-3.05, p(trend )= 0.049). Conclusions: These data suggest an inverse association of 25(OH)D with diabetes and MS and a positive association of PTH with obesity and hypertension among patients with OSAS. Based on our observational study, the causative nature of the associations cannot be established. These findings require further examination in prospective studies including clinical trials.
    Respiration 11/2012; 86(4). DOI:10.1159/000342748 · 2.92 Impact Factor
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    ABSTRACT: Automatic CPAP devices have demonstrated good results in obtaining optimal fixed CPAP pressure to eliminate respiratory events in patients with sleep apnea-hypopnea syndrome (SAHS). However, automatic CPAP has not been fully studied in patients with COPD plus SAHS. To analyse the performance of an automatic CPAP in severe COPD patients compared with SAHS patients with no associated co-morbidity. We compared 10 consecutive patients with SAHS and no associated co-morbidity and 10 patients with SAHS plus severe COPD who required CPAP titration. Automatic CPAP performance was studied during full-night PSG. Inadequate pressure increase periods, absence of pressure increases in reaction to respiratory events, air leak periods, and pressure behaviour in the face of erratic breathing periods were analysed. The SAHS patients without co-morbidities vs. SAHS plus COPD patients presented: mean sleep efficiency, 80.2 (11.5)% vs. 76.5 (12.1)%; residual AHI, 6.3 (5.2) vs. 5.1 (7.7); residual CT90, 1 (3)% vs. 14 (1)%. The device´s performance demonstrates a mean of 1.2 (1.5) vs. 1.3 (1.2) periods of inadequate pressure increases; absence of pressure increases in reaction to respiratory events, 4.1 (5.4) vs. 0.6 (0.7) times; periods of air leaks, 1.3 (3.8) vs. 13.9 (11.7); mean optimal pressure, 9.1 (1.4) vs. 9.0 (1.9) cm H(2)O. Titration with automatic CPAP could be as effective in patients with SAHS plus severe COPD as in patients with SAHS without COPD. However, the presence of more leakages must be taken into account.
    COPD Journal of Chronic Obstructive Pulmonary Disease 04/2012; 9(4):382-9. DOI:10.3109/15412555.2012.670329 · 2.62 Impact Factor
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    ABSTRACT: Obstructive sleep apnea syndrome (OSAS) is a complex disease with a strong genetic basis. One of the primary molecular domains affected by OSAS is sympathetic activity. Neuropeptide S (NPS) plays an important role in the regulation of the sleep-wakefulness cycle, anxiety states, and daytime sleepiness. It is important to study neuropeptides related to sympathetic activity regulation and how their function could be modified by genetic variants affecting the expression of these molecules. We investigated the association of the non-synonymous polymorphism rs4751440 in the NPS precursor gene with OSAS and certain variables related to OSAS (daytime sleepiness, body mass index (BMI), insulin resistance, and blood pressure). This polymorphism causes an amino acid substitution in exon 3 of the human NPS precursor gene. We included 253 OSAS patients and 70 healthy subjects. Genotyping was done by polymerase chain reaction using specific flanking primers and agarose gel electrophoresis. Daytime sleepiness, BMI, plasma levels of high-density lipoprotein, glucose, total cholesterol, insulin, triglycerides, and the homeostasis model assessment index were also determined. A similar genotypic and allelic distribution was found in OSAS patients and controls. The risk of OSAS was not associated with the rs4751440 polymorphism. There was no significant interaction between daytime sleepiness or metabolic variables and the rs4751440 polymorphism. Genotypic and allelic frequency distribution of the rs4751440 polymorphism was similar in OSAS patients and controls. In this population-based study, we could not show a significant association between rs4751440 polymorphism and susceptibility to OSAS or certain phenotypes related to OSAS (daytime sleepiness, BMI, systolic blood pressure, and insulin resistance) with the exception of diastolic blood pressure.
    Sleep And Breathing 09/2011; 15(3):403-8. DOI:10.1007/s11325-010-0348-1 · 2.87 Impact Factor
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    ABSTRACT: Health-related quality-of-life (HRQL) tests used in sleep apnea-hypopnea syndrome (SAHS) are time-consuming, complicating their application in clinical practice. The objective was to examine the validity and responsiveness of a simple visual analogical well-being scale (VAWS) for the clinical use. The subjects proceed from a cohort of SAHS patients treated with CPAP for 12 weeks. We correlated the VAWS with other HRQL tests, related clinical and polysomnographic measures to concurrent and construct validities. Responsiveness by: (1) comparison of HRQL tests between before and after treatment and effect size. (2) Association of the change with treatment between VAWS with other HRQL tests and between VAWS with clinical parameters. At baseline, VAWS correlated with all HRQL tests but better with functional outcomes in sleep questionnaires (FOSQ) and European quality-of-life questionnaire (EuroQol) thermometer. VAWS and FOSQ correlated better with clinical variables than other HRQL tests. VAWS captures the magnitude change with treatment similarly to FOSQ but better than other HRQL tests. VAWS is a very simple test which measures HRQL in SAHS. It could be a useful tool in clinical practice, primarily for the responsiveness of treatment.
    Sleep And Breathing 09/2011; 15(3):549-59. DOI:10.1007/s11325-010-0399-3 · 2.87 Impact Factor
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    Archivos de Bronconeumología 03/2011; 47(3):143-156. · 2.17 Impact Factor
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    ABSTRACT: To improve the performance of simplified sleep studies, it is essential to properly estimate the sleep time. Our aim is to estimate sleep efficiency on the basis of flow breathing signal characteristics. Twenty subjects with sleep apnea-hypopnea syndrome diagnosed by polysomnography were studied. A characteristic pattern of flow signal defined our criteria for wakefulness and sleep. Sleep was analyzed in 2 different runs: (1) in the usual manner (neurological and respiratory variables), and (2) only the nasal cannula flow signal was displayed on the computer screen and the sleep and wakefulness periods were scored according to our criteria. At the end of the scoring process, all the signals were displayed on the screen to analyze the concordance. Three thousand and sixty-nine screens were analyzed. The polysomnography sleep efficiency measured was 80.8%. The estimated sleep efficiency measured by nasal prongs was 78.9%. The detection and concordance of wakefulness had a sensitivity of 58.7%, a specificity of 96.4%, a positive predictive value of 81.3% and a negative predictive value of 89.6%. Our criteria for sleep and wakefulness based on airflow waveform morphology are a helpful parameter for estimating sleep efficiency in a simplified sleep study.
    Respiration 12/2009; 80(6):495-9. DOI:10.1159/000264656 · 2.92 Impact Factor
  • American Thoracic Society 2009 International Conference, May 15-20, 2009 • San Diego, California; 04/2009
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    ABSTRACT: Excessive daytime sleepiness (EDS) is the major complaint in subjects with obstructive sleep apnea syndrome (OSAS). However, EDS is not universally present in all patients with OSAS. The mechanisms explaining why some patients with OSAS complain of EDS whereas others do not are unknown. To investigate polysomnographic determinants of excessive daytime sleepiness (EDS) in a large multicenter cohort of patients with obstructive sleep apnea (OSAS). All consecutive patients with an apnea-hypopnea index greater than 5h(-1) who were evaluated between 2003 and 2005. EDS was assessed using the Epworth Sleepiness Scale (ESS), and patients were considered to have EDS if the ESS was >10. A total of 1649 patients with EDS ((mean [+/-SD] Epworth 15+/-3) and 1233 without EDS (Epworth 7+/-3) were studied. Patients with EDS were slightly younger than patients without EDS (51+/-12 vs 54+/-13 years, p<0.0001), had longer total sleep time (p<0.007), shorter sleep latency (p<0001), greater sleep efficiency (p<0.0001) and less NREM sleep in stages 1 and 2 (p<0.007) than those without EDS. Furthermore, patients with EDS had slightly higher AHI (p<0.005) and arousal index (p<0.001) and lower nadir oxygen saturation (p<0.01). Patients with OSAS and EDS are characterized by longer sleep duration and increased slow wave sleep compared to those without EDS. Although patients with EDS showed a mild worsening of respiratory disturbance and sleep fragmentation, these results suggest that sleep apnea and sleep disruption are not the primary determinants of EDS in all of these patients.
    Sleep Medicine 05/2008; 9(7):727-31. DOI:10.1016/j.sleep.2008.02.006 · 3.10 Impact Factor
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    ABSTRACT: The episodes of hypoxia/re-oxygenation associated with the respiratory disturbances observed in patients with obstructive sleep apnoea syndrome (OSAS) may induce the generation of oxygen free radicals. Indeed, several studies suggest that OSAS is associated with oxidative stress. The present study tested the hypothesis that patients with OSAS have an alteration in antioxidant defences. The plasma levels of total antioxidant status (TAS), glutathione peroxidase (GPX), gamma-glutamyltransferase (GGT), vitamins A, E, B12 and folate, and homocysteine were determined in 47 patients with OSAS and 37 healthy subjects. Of these, 27 patients who used continuous positive airway pressure (CPAP) for >4 h.night-1 were re-examined 12 months later. Patients with OSAS had lower TAS (1.4+/-0.16 versus 1.50+/-0.10 mmol.L-1), vitamin A (64+/-19 versus 74+/-17 microg.dL-1) and vitamin E levels (1,525+/-499 versus 1,774+/-503 microg.dL-1), and increased values of GGT (42+/-22 versus 32+/-16 U.L-1) than controls. There was no difference between groups in GPX, homocysteine, vitamin B12 and folate plasma levels. CPAP treatment normalised the levels of TAS (1.50+/-0.13 mmol.L-1) and the activity of GGT (30+/-14 U.L-1) without any influence on vitamins levels. In conclusion, the results indicate that patients with obstructive sleep apnoea syndrome have a decreased antioxidant capacity that is partially reversed by continuous positive airway pressure treatment.
    European Respiratory Journal 05/2006; 27(4):756-60. DOI:10.1183/09031936.06.00067605 · 7.13 Impact Factor
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    ABSTRACT: Standard practice for continuous positive airway pressure (CPAP) treatment in sleep apnea and hypopnea syndrome (SAHS) requires pressure titration during attended laboratory polysomnography. However, polysomnographic titration is expensive and time-consuming. The aim of this study was to ascertain, in a large sample of CPAP-naive patients, whether CPAP titration performed by an unattended domiciliary autoadjusted CPAP device or with a predicted formula was as effective as CPAP titration performed by full polysomnography. The main outcomes were the apnea-hypopnea index and the subjective daytime sleepiness. We included 360 patients with SAHS requiring CPAP treatment. Patients were randomly allocated into three groups: standard, autoadjusted, and predicted formula titration with domiciliary adjustment. The follow-up period was 12 weeks. With CPAP treatment, the improvement in subjective sleepiness and apnea-hypopnea index was very similar in the three groups. There were no differences in the objective compliance of CPAP treatment and in the dropout rate of the three groups at the end of the follow-up. Autoadjusted titration at home and predicted formula titration with domiciliary adjustment can replace standard titration. These procedures could lead to considerable savings in cost and to significant reductions in the waiting list.
    American Journal of Respiratory and Critical Care Medicine 01/2005; 170(11):1218-24. DOI:10.1164/rccm.200312-1787OC · 11.99 Impact Factor
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    Juan F Masa · José M Montserrat · Joaquín Durán
    American Journal of Respiratory and Critical Care Medicine 08/2004; 170(2):195; author repy 195-6. DOI:10.1164/ajrccm.170.2.950 · 11.99 Impact Factor
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    ABSTRACT: Given the high prevalence of sleep apnea/hypopnea syndrome (SAHS) and great demand for conventional polysomnography (PSG) and long waiting lists, alternative means for diagnosing SAHS and titrating continuous positive airway pressure (CPAP) are needed. Automatic CPAP may play a role in meeting the last objective, not only for treatment but also for suggesting the optimum CPAP setting. a) To define a protocol to assess the functioning of an automatic CPAP device by means of a mechanical model; b) to determine the behavior of automatically adjusted CPAP during PSG; c) to define the usefulness of automatic CPAP for indicating optimal CPAP pressure for patients with SAHS; d) to evaluate the efficacy of the automatically indicated pressure setting against conventional PSG. Four protocols were carried out using the Autoset-T (AT) device. 1. Apneas, hypopneas, flow limitation, snoring and normal flow were simulated in a laboratory using a mechanical model in order to check AT functioning. 2. The behavior of the automatically adjusted CPAP was observed in real time during PSG in 12 patients with severe SAHS. 3. The agreement of CPAP titrated with the AT and with PSG was checked in a group of 39 patients with SAHS. 4. The efficacy of the CPAP pressure recommended by the AT was checked by PSG in a group of 14 patients with SAHS. With the AT, CPAP increased rapidly in response to apneas or snoring in the mechanical model and during conventional PSG; it took only a mean 2.8 3.1 min to rise from a baseline pressure of 4 cm H2O to a near-optimum pressure of 11 1 cm H2O. Once normal flow was reached CPAP slowly decreased, responding with great sensitivity to the slightest abnormality, especially snoring, but not changing in response to certain types of flow limitation. The pressure read visually on the AT was similar to the one recommended by PSG in most of the 39 patients (71%). The PSG performed after one month of using AT-recommended CPAP titration confirmed that the number of apneas, hypopneas (apnea/hypopnea index 6(1) and arousals (8 2) was normal for these SAHS patients. The AT increases pressure rapidly in the presence of respiratory events and maintains a normal breathing pattern in most patients. Visual reading of the AT pressure allows correct identification of the optimal CPAP setting for SAHS treatment.
    Archivos de Bronconeumología 04/2003; 39(3):118-25. DOI:10.1016/S0300-2896(03)75338-1 · 1.82 Impact Factor
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    ABSTRACT: The aim of this trial was to evaluate the effectiveness of continuous positive airway pressure (CPAP) in patients with mild sleep apnea- hypopnea syndrome (SAHS). One hundred forty-two consecutive patients with mild SAHS (apnea-hypopnea index 10-30, without severe sleepiness) were randomly assigned to receive conservative treatment (CT)-sleep hygiene and weight loss-(65 patients) or CT plus CPAP (77 patients), and 125 patients (86% males, age: 54 +/- 9 yr, BMI: 29 +/- 4 kg/m(2), AHI: 20 +/- 6, ESS: 12 +/- 4) completed the follow-up. The following outcomes were assessed at inclusion and after 3 and 6 mo of treatment: sleepiness (Epworth scale, multiple sleep latency test [MSLT]), other symptoms related to SAHS, cognitive function, and perceived health status (Functional Outcomes of Sleep Questionnaire [FOSQ], Nottingham Health profile). The relief of SAHS-related clinical symptoms was significantly greater in the CPAP group than in the CT group; the Epworth scale and FOSQ also showed more improvement in the CPAP group but did not reach significance. There were no significant differences in the other tests performed probably because the baseline values were normal. CPAP compliance was 4.8 +/- 2.2 h and treatment continuation was accepted by 62% of the patients at the end of the study. These results suggest that CPAP can be considered in treating patients with mild SAHS on the basis of an improvement in symptoms.
    American Journal of Respiratory and Critical Care Medicine 10/2001; 164(6):939-43. DOI:10.1164/ajrccm.164.6.2008010 · 11.99 Impact Factor
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    ABSTRACT: The sleep apnea-hypopnea syndrome is defined by a pathologic number of respiratory events during sleep (the apnea-hypopnea index, defined as the number of apnea and hypopnea episodes per hour) and daytime symptoms (mostly, excessive sleepiness). In patients with the sleep apnea syndrome, treatment with continuous positive airway pressure (CPAP) normalizes both the apnea-hypopnea index and diurnal symptoms. However, the effect of CPAP in persons with a pathologic apnea-hypopnea index without daytime sleepiness is unclear. To investigate the short-term effects of CPAP on quality of life, objective sleepiness, cognitive function, and arterial blood pressure in nonsleepy patients with a pathologic apnea-hypopnea index. Multicenter randomized, placebo-controlled, parallel-group study. Six teaching hospitals in Spain. 55 patients with an apnea-hypopnea index of 30 or greater who did not have daytime sleepiness (Epworth Sleepiness Scale score </= 10). Patients were randomly assigned to receive optimal (n = 29) or sham (n = 25) CPAP and were observed for 6 weeks. Quality of life, objective sleepiness (Multiple Sleep Latency Test score), cognitive function, and arterial blood pressure. The intervention and control groups were similar in terms of mean (+/-SE) age (54 +/- 2 vs. 52 +/- 2 years), apnea-hypopnea index (54 +/- 3 vs. 57 +/- 4), Epworth Sleepiness Scale score (7.0 +/- 0.4 vs. 7.0 +/- 0.4) and adherence to CPAP treatment (5.0 +/- 0.4 vs. 4.0 +/- 0.5 hours/d). Other variables, such as quality of life, cognitive function, and arterial blood pressure, were also similar in both groups before treatment. After 6 weeks of CPAP or sham CPAP, none of these variables changed significantly. In patients with an apnea-hypopnea index of 30 or greater and no subjective daytime sleepiness, CPAP does not modify quality of life, objective sleepiness, vigilance, attention, memory, information processing, visuomotor coordination, or arterial blood pressure. Treatment with CPAP is therefore not indicated in nonsleepy patients with a pathologic apnea-hypopnea index.
    Annals of internal medicine 06/2001; 134(11):1015-23. DOI:10.7326/0003-4819-134-11-200106050-00007 · 16.10 Impact Factor
  • Archivos de Bronconeumología 05/1998; 34(4):204-6. · 1.82 Impact Factor
  • Archivos de Bronconeumología 12/1995; 31(9):460-2. · 1.82 Impact Factor