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ABSTRACT: To examine whether differentially expressed proteins are present in the serum of patients with obstructive sleep apnoea (OSA), iTRAQ techniques (isobaric tags for relative and absolute quantification) were employed in a prospective study. Individuals were assigned to either a non-OSA control group (apnoea-hypopnoea index, AHI <5) or an OSA group (AHI ≥5). Blood samples were collected, aliquoted and frozen at -80 °C. Protein digestion and tagging with iTRAQ4plex® and mass spectrometry analysis was then performed (MALDI TOF/TOF). Ten male subjects were included in the control group (age = 45 ± 9.7 years) and 30 male patients in the OSA group (age = 45 ± 10.7 years), the latter being then subdivided into three severity groups. A total of 103 proteins were identified with differential levels between patients with OSA and controls. Of these, 11 proteins were underexpressed and 19 were overexpressed in patients with OSA. C4BPA and thrombospondin were underexpressed in all three OSA severity groups. Among the overexpressed proteins, 13 were overexpressed in the mild OSA group, seven in the moderate group and five in the severe group. Analysis of interactions between the identified proteins revealed that protein alterations in OSA are primarily associated with derangements in lipid and vascular metabolic pathways. This study provides initial evidence that differential protein expression occurs in adults with OSA, and that such proteins change according to disease severity, and appear to primarily involve lipid and vascular metabolic pathways.
Journal of Sleep Research 09/2011; 21(2):139-46. · 3.16 Impact Factor
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ABSTRACT: A prospective study with a consecutive sample and a control group to determine whether protein expression in patients with sleep apnoea-hypopnoea syndrome (SAHS) is different from that of the control group (IAH < or =5).
A total of 32 patients aged between 35 and 60 years who had a polysomnograph performed were included. Patients with an acute or chronic were excluded. The first dimension of the proteomic study was carried out on IPG strips (18cm, pH 4-7) and the second on SDS-PAGE gels in triplicate for each group. The gels were stained with SYPRO-Ruby (Bio-Rad((R))), the images obtained with an FX-Imager laser scanner and the spots were analysed using ProteomWeaver v. 4.0 (Bio-Rad((R))) software. Significant changes between the gels were analysed by replicates and separately, being considered a significant change if the relative intensity of the spots was three times higher or lower than that of the control and if it was observed in 2 of the 3 replicates of each group, with a coefficient of variation of <20%.
The patients were divided into 8 subjects per group (control, mild, moderate and severe). The comparison of the gels showed significant differences between the control group and the 3 clinical groups, with significant over-expression being observed in 3 spots, and under-expression in 7 spots in the control group.
There are significant changes in protein expression between a control group and patients in different stages of disease. The proteomic study can identify biomarkers associated with the diagnosis and severity of the SAHS.
Archivos de Bronconeumología 02/2010; 46(6):288-93. · 2.17 Impact Factor
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ABSTRACT: To assess whether kidney transplantation improves sleep-related breathing disorders associated with hemodialysis.
A prospective study was carried out using full-night polysomnography. Nine hemodialysis patients (7 men and 2 women, aged 42 +/- 16.2 years, BMI 26 +/- 3.7) who later received a successful kidney transplantation were evaluated. Main sleep quality and respiratory variables were recorded: number of dips in oxygen saturation (SaO(2)) > or =3% per hour of sleep; percentage of sleep time with SaO(2) <90%; percentage of sleep time in apnea and hypopnea, and sleep apnea/hypopnea index (AHI).
After kidney transplantation, the AHI improved in 8 of the 9 patients (10 +/- 10.7 vs. 4.9 +/- 6.1, p = 0.029). A decrease in the percentage of sleep time in apnea/hypopnea (5 +/- 6.8 vs. 0.7 +/- 1.1%, p = 0.008) and a reduction in the number of desaturations (25 +/- 26 vs. 12 +/- 11.2%, p = 0.010) were observed.
Kidney transplantation improved respiratory events and nocturnal SaO(2) in hemodialysis patients.
Blood Purification 10/2008; 26(6):485-90. · 2.10 Impact Factor
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ABSTRACT: Airway complications remain a critical source of morbidity and mortality after lung transplantation, and bronchial stenosis is the most frequent. Mitomycin C, an antineoplastic agent that inhibits fibroblast proliferation, has been applied topically in the upper airway and trachea. On the basis of our experience of treating tracheal stenosis with mitomycin C, this technique has been employed with the objective of preventing restenosis in pulmonary transplant patients. We report, what we believe to be the first 2 cases of patients successfully treated with topical mitomycin C for recurrent bronchial stenosis after lung transplantation.
Journal of Bronchology & Interventional Pulmonology. 09/2008; 15(4):281-283.
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ABSTRACT: To evaluate the prevalence of sleep disorders in patients awaiting kidney transplants compared to a control group.
We carried out an observational study of 23 patients on a kidney transplant waiting list in comparison with 20 healthy volunteers matched for age, sex, and body mass index (BMI). Overnight polysomnography was performed and a diagnosis of sleep apnea-hypopnea syndrome (SAHS) established when the apnea-hypopnea index (AHI) was 10 or higher.
Eighty-two percent of the patients awaiting kidney transplants (16 men and 7 women with a mean [SD] age of 51 [15] years and a mean BMI of 25 [3.8] kg/m2) had some type of sleep disorder. The most frequent disorders were SAHS (48%) and insomnia and periodic limb movement disorder (30%). Patients showed poorer sleep efficiency compared to the control group (75.4% vs 87.8%; P=.01) and a lower percentage of slow-wave and rapid eye movement sleep (24.5% vs 40%; P=.001). Those with sleep-disordered breathing had a higher AHI (17.7 vs 3.6; P=.001) and oxygen desaturation index (31.5 compared to 8.2; P=.001).
Sleep disorders are common in patients awaiting kidney transplants. Such patients show reduced quantity and quality of sleep compared to controls and a significantly elevated number of respiratory events that may affect morbidity and mortality.
Archivos de Bronconeumología 08/2008; 44(7):371-5. · 2.17 Impact Factor
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ABSTRACT: Lack of adherence to inhaled corticosteroid therapy is common in patients with asthma, and it has been suggested that allowing patients to choose their own inhalers would resolve this problem. The FSI-10 (Feeling of Satisfaction with Inhaler) is a self-completed questionnaire to assess patient opinions regarding ease or difficulty of use, portability, and usability of devices for delivery of inhaled corticosteroids. The aim of this study was to define the measurement properties of the FSI-10 questionnaire and to use this inventory to compare satisfaction and preferences of patients with asthma regarding 3 different devices for delivery of inhaled corticosteroids: Turbuhaler, Accuhaler, and Novolizer.
We performed a multicenter, prospective, observational study in 112 stable asthmatic patients (64 women; mean [SD] age, 37 [22] years) treated on a regular basis with inhaled corticosteroids. The use of the devices was explained to the patients and the order in which they should be used in each case was randomly assigned. The devices were used for 7-day periods and at the end of each the FSI-10 questionnaire was completed for the device used. Once the protocol was completed, patients stated their preference for the different devices used.
The FSI-10 was easily understood and rapidly completed, and it exhibited acceptable measurement properties. Factor analysis showed that the measure was unidimensional. Although acceptance of all 3 devices assessed was reasonable, the FSI-10 questionnaire detected significant differences between them: Turbuhaler and Novolizer scored higher than Accuhaler on a number of questions. This preference is partly explained by Turbuhaler having been the device that was commonly used by the patients prior to the study. However, the highest scoring and most often preferred inhaler in patients under 16 years of age was the Novolizer, even though the Turbuhaler had also usually been used by those patients prior to the study.
The FSI-10 is a useful instrument for assessing the degree of satisfaction of asthmatic patients regarding available inhalation devices. It is easy to understand and complete, and able to identify differences in patient satisfaction with the different inhalers.
Archivos de Bronconeumología 08/2008; 44(7):346-52. · 2.17 Impact Factor
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ABSTRACT: To assess the diagnostic validity, degree of patient satisfaction, and economic cost of home sleep monitoring compared to conventional polysomnography.
Consecutive patients with symptoms indicative of sleep apnea-hypopnea syndrome (SAHS) were included. We analyzed the diagnostic yield of home sleep monitoring using the apnea-hypopnea index (AHI), number of desaturations of at least 3%, and the percentage time with arterial oxygen saturation below 90%. The degree of patient satisfaction, measured on a visual analogue scale, and the cost of home monitoring were compared with conventional polysomnography.
The study included 52 patients (42 men and 10 women) with a mean (SD) age of 51.8 (9) years and a body mass index of 32 (5) kg/m2. Polysomnography and home monitoring revealed an AHI of 33.6 (20) and 31 (19), respectively (r=0.971; intraclass correlation coefficient = 0.963; P< .001). The number of desaturations of at least 3% and the percentage time with arterial oxygen saturation below 90% showed significant correlation and concordance (P< .05). For an AHI cutoff of 10 recorded with polysomnography, home monitoring had a sensitivity of 89% and a specificity of 80%, with an area under the receiver operator characteristic curve of 0.804. For severe SAHS (AHI> or =30), the sensitivity and specificity of home monitoring was 100% (that is, the area under the receiver operating characteristic curve was 1). For home monitoring, the cost per diagnostic test was 101.34 euro less than that of polysomnography, and the patient satisfaction was significantly greater (P< .0001).
Home sleep monitoring is a valid and cost-effective diagnostic test; patients with symptoms of SAHS are more satisfied with this technique than conventional polysomnography.
Archivos de Bronconeumología 11/2007; 43(11):605-10. · 2.17 Impact Factor
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ABSTRACT: We report a case of hydatid cyst with intrabronchial growth accompanied by chronic cough and pulmonary consolidation. The patient was diagnosed with pneumonia and was treated accordingly. Several months later, due to the persistence of atelectasis of the lingula, a bronchoscopy was performed, revealing the presence of an intrabronchial tumor in the inferior segment of the lingula. The lesion was biopsied, revealing a hydatid cyst. The patient underwent a lingulectomy without complications.
Hydatid disease is a zoonosis caused by Echinococcus spp. Seen worldwide, E. granulosus is the most common, and is endemic in Spain. 1 Hepatic disease is the most frequent presentation, with approximately 65 to 75% of hydatid cysts located in the liver, whereas 15 to 25% of cases are observed in the lungs. Only 10% of cases are located in other organs. 1,2
Few symptoms are observed in the lungs and diagnosis is uncommon before the rupture of the cyst toward adjacent structures such as bronchi or pleura has occurred. In such cases the clinical presentation is variable and unspecific. The most frequent symptoms are cough, fever, hemoptysis, and chest pain. Radiologic findings of pulmonary nodules or masses is common. 3,4
We report an exceptional case of pulmonary hydatidosis that presented clinically as pneumonia secondary to atelectasis due to an endobronchial tumor.
Journal of Bronchology & Interventional Pulmonology. 06/2003; 10(3):192-194.
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ABSTRACT: Introduction: episodes of hypoxemia-reoxigenation are frequent in sleep apnea-hypopnea syndrome (SAHS) and can produce reactive oxygen substances and oxidative stress. Patients and methods: prospective study, with consecutive sampling to determine if nocturnal hypoxemia can produce oxidation. Patients with SAHS suspicion, polysomnography indication, age between 25-49 years old and without systemic disease were included. Results obtained in clinical group (IAH > 10) were compared with control group (IAH < 5). Results: three patients with IAH 5-10 were excluded. Thirty-six subjects were included (age: 40 ± 6.1 years old, 30 men and 6 women, BMI = 31 ± 5.9), 23 patients were from clinical group and 13 from control group. In clinical group, carbonylated proteins values were 0.14 ± 0.179 nmol/mg and 0.10 ± 0.066 nmol/mg in control group (p = 0.348). There was not significative correlation between carbonyl proteins and apnea-hypopnea index (rho = 0.197, p = 0.249), desaturation index >3% (rho = 0.129, p = 0.452) and sleep time spent with SaO2 <90% (rho = 0.058, p = 0.736). Conclusions: in patientes with mean age and moderate SAHS, protein carbonyls were higher althout not reaching significant differences. Introducción: en el síndrome de apneas-hipopneas del sueño (SAHS) son frecuentes los episodios de hipoxemia-reoxigenación que pueden producir sustancias oxígeno reactivas y estrés oxidativo. Pacientes y método: estudio prospectivo, con muestreo consecutivo, para determinar si la hipoxemia nocturna puede provocar oxidación proteica. Fueron incluidos pacientes con sospecha de SAHS, indicación de una polisomnografía, edad comprendida entre 25 y 49 años, y ausencia de enfermedad sistémica. Se compararon los resultados observados en un grupo clínico (IAH > 10) con los de un grupo control (IAH < 5). Resultados: se excluyeron 3 pacientes por presentar un IAH entre 5 y 10. Fueron incluidos 36 sujetos (edad = 40 ± 6,1 años, 30 hombres y 6 mujeres, IMC = 31 ± 5,9), 23 pertenecientes al grupo clínico y 13 al grupo control. En el grupo clínico, los valores de proteínas carboniladas fueron de 0,14 ± 0,179 nmol/mg y de 0,10 ± 0,066 nmol/mg en el grupo control (p = 0,348). No se observó correlación significativa entre las cifras de proteínas carboniladas y el índice de apneas-hipopneas (rho = 0,197; p = 0,249), índice de desaturación >3% (rho = 0,129, p = 0,452) y porcentaje de sueño con SaO2 <90% (rho = 0,058, p = 0,736). Conclusiones: en pacientes con edad media y SAHS moderado, las proteínas carboniladas séricas se observaron más elevadas, aunque sin alcanzar diferencias significativas.
Revista Neumosur, ISSN 0214-6266, Vol. 21, Nº. 3, 2009, pags. 154-158.
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ABSTRACT: The bronchiectases are not a homogeneous defined entity since they can be the expression of several aetiologies and, very possibly, of several pathogenic mechanisms that are constituted in a vicious circle of alteration of the mucociliary clearance, inflammation and chronic bacterial infection. The different therapeutic options available try to control these aspects and the final objectives are the control of the symptoms, the prevention of progression and the reduction of morbidity. At present the clinical evidence that supports the treatment of this pathology is scarce, but its multidisciplinary evaluation can change its natural history Las bronquiectasias no son una entidad nosológica homogénea ya que pueden ser la expresión de varias etiologías y, muy posiblemente, de varios mecanismos patogénicos que se constituyen en un círculo vicioso de alteración del aclaramiento mucociliar, inflamación e infección bacteriana crónica. Las diferentes opciones terapéuticas disponibles pretenden controlar estos aspectos y los objetivos finales son el control de los síntomas, la reducción de la morbilidad y la prevención de la progresión. En la actualidad la evidencia clínica que soporta el tratamiento de esta patología es escasa pero la valoración multidisciplinar de la misma puede hacer cambiar su historia natural
Revista Neumosur, ISSN 0214-6266, Vol. 18, Nº. 3, 2006, pags. 143-150.
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ABSTRACT: Objetives: To evaluate the quality of the sleep and sleep disorders breathing in patients with chronic kidney disease stage 4-5 (CKD4-5) and in hemodialysis respect healthy population. In addition, to study in these last ones, the prevalence of the obstructive sleep apnea-hypoapnea syndrome (SAHS) and the existence of some analytical marker associated to SAHS. Patients and methods: There were studied 32 patients with CKD in hemodialysis (24 men and 8 women, age of 54±16, BMI of 25±3.9), 14 patients with CKD 4-5 and a group of 14 healthy subjects; these groups were matched for age, gender, and BMI with the hemodialysis group. All of them were studied with a clinical history and a overnight polisomnography. We stablished the diagnostic of SAHS when the apnea-hypoapnea index (AHI) ?10. Results: Patients with CKD 4-5 showed worse quality of sleep and more episodes of AHI respect healthy control group, although without statistic signification. The group in hemodialysis had less quantity and worse quality of sleep than the control group with an AHI significatly higher (4.3 ± 1.44 vs 19.1 ± 18.5, p:0.007) and more decreases of the SaO2 (9.9 ± 5.15 vs 26.5 ± 17.81, p:0.011). 78% of the patients in hemodialysis suffered some sleep disorder, emphasizing the SAHS (48%). The serum creatinine and the eKt/v were independently associated with the AHI (R2: 0.219, p: 0.028). Conclusions: The sleep disorder is a prevalent pathology in the CKD. Patients in hemodialysis show a elevated AHI and of intermittent hypoxia, that must be avoided in these patients with an elevated cardiovascular mortality. Only, the levels of creatinine and the eKt/v explain partially the variability of the AHI. Objetivos: Respecto a población sana, se evalúan los trastornos del sueño en enfermos con enfermedad renal crónica estadio 4- 5 (ERC 4-5) y hemodiálisis. En estos últimos se estudia la prevalencia del síndrome de apneas-hipopneas del sueño (SAHS) y algún marcador analítico asociado independientemente al SAHS. Pacientes y Método: fueron estudiados 32 pacientes en hemodiálisis (24 hombres y 8 mujeres, edad: 54 ± 16, IMC: 25 ± 3.9), 14 enfermos con ERC 4-5 y 14 sujetos sanos. Estos dos últimos grupos, pareados por edad, género e IMC con el grupo en hemodiálisis. Se les realizó una historia clínica y una polisomnografía diagnóstica, estableciéndose el diagnóstico de SAHS ante un índice de apnea-hipopnea (IAH) ? 10. Resultados: Respecto al grupo control sano, los pacientes con ERC 4-5 muestran peor calidad de sueño y un mayor IAH, aunque sin significación estadística, mientras el grupo en hemodiálisis presenta menos cantidad y peor calidad de sueño, un IAH significativamente elevado (4.3 ± 1.44 vs 19.1 ± 18.5, p:0.007) y un mayor número de descensos en la SaO2 (9.9 ± 5.15 vs 26.5 ± 17.81, p:0.011). Un 78% de los enfermos en hemodiálisis presentaban algún trastorno del sueño, destacando el SAHS (48%). La creatinina y el eKt/V se asociaron con el IAH (R2:0.219, p: 0.028). Conclusiones: El SAHS es frecuente en la IRC. Los pacientes en hemodiálisis muestran un elevado IAH y de hipoxia intermitente que deben evitarse en estos pacientes con mortalidad cardiovascular elevada. Únicamente las cifras de creatinina y eKt/V explican parcialmente la variabilidad del IAH.
Revista Neumosur, ISSN 0214-6266, Vol. 19, Nº. 4, 2007, pags. 171-178.
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ABSTRACT: BACKGROUND: Polygraphy is an alternative diagnoses technique in the sleep apnea syndrome (SAS), although is infrequent to perform the studies at patients home. This study aims to compare the diagnoses validity of home polygraphy with conventional polysomnography in patients with moderate and high clinical suspicion of SAS, as well as valorating the grade of satisfaction. PATIENTS AND METHODS: On a selected sample, a randomized blinded study was performed analizing the degree of satisfaction of the patient by an analogic visual scale and the diagnostic validity of home polygraphy versus standard polysomnography comparing the apnea hypopnea index (AHI) obtained from both tests. RESULTS: Thirty four patients are studied (25 men and 8 women), middle age (�}SD) of 53,4�} 11 years old and a body mass index of 33�} 5 kg/m2. For an AHI .10 obtained after polysomnography, polygraphy represents a sensitivity of 90,3%, especificity of 50%, a positive predictive value of 96,5% and a negative predictive value of 25%, finding an area under the ROC curve of 0,863. In a severe SAS (AHI.30) polygraphy obtains a sensitivity of 88,2% (72,9-100) and a especificity of 100% with an area under the ROC curve of 1. AHI obtained after polygraphy compared with polysomnography (33,70�}22,38 and 36,36�}22,09 respectively) shows a high correlation with a value of r:0,975 (p<0,0001) and a high concordance with a coefficient of correlation intraclass of 0,968. Score after polysomnography was 7,5 and 9 after polygraphy, when expressing the patients satisfaction grade (p<0,0001). CONCLUSIONS: On a selected sample, home polygraphy shows a high correlation and concordance with polysomnography, being a valid technique for the diagnoses with a higher patient satisfaction grade. FUNDAMENTO: En el sindrome de apnea obstructiva del sueno (SAOS), la poligrafia es una alternativa diagnostica, aunque son infrecuentes los estudios realizados en el domicilio del paciente. El objetivo de este estudio es comparar la validez diagnostica de la poligrafia domiciliaria respecto a la polisomnografia convencional, en pacientes con moderada y alta sospecha clinica de SAOS, ademas de valorar el grado de satisfaccion. PACIENTES Y METODOS: En una muestra seleccionada, se realizo un estudio aleatorio y ciego analizando el grado de satisfaccion del paciente mediante una escala visual analogica y la utilidad de la poligrafia domiciliaria frente a la polisomnografia estandar comparando el IAH (indice de apnea-hipopnea) obtenido en ambas pruebas. RESULTADOS: Se estudian 33 enfermos (25 hombres y 8 mujeres), edad media (�} DE) de 53,4 �} 11 anos y un indice de masa corporal de 33 �} 5 kg/m2. Para un IAH . 10 obtenido en la polisomnografia, la poligrafia presenta una sensibilidad del 90,3%, una especificidad del 50%, un valor predictivo positivo del 96,5% y un valor predictivo negativo del 25%, encontrandose un area bajo la curva ROC de 0,863. En un SAOS grave (IAH >30) la poligrafia obtiene una sensibilidad del 88,2% (72,9-100) y una especificidad del 100% con un area bajo la curva ROC de 1. El IAH obtenido en la poligrafia comparado con el de la polisomnografia (33,70 �}22,38 y 36,36 �}22,09, respectivamente) muestra una alta correlacion con un valor de r:0,975 (p<0,0001) y una elevada concordancia con un coeficiente de correlacion intraclase de 0,968. La puntuacion de la polisomnografia fue de 7,5 y de 9 para la poligrafia, al expresar el grado de satisfaccion los pacientes (p<0,0001). CONCLUSIONES: En una muestra seleccionada, la poligrafia domiciliaria muestra una alta correlacion y concordancia con la polisomnografia, siendo una prueba valida para el diagnostico con un mayor grado de satisfaccion para el paciente.
Revista Neumosur, ISSN 0214-6266, Vol. 17, Nº. 3, 2005, pags. 184-189.
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ABSTRACT: Introduction: Respiratory rehabilitation (RR) is a beneficial therapy for those patients with chronic obstructive pulmonary disease (COPD). However, the application of the majority of the programmes designed demands a high consumption of resources and few have demonstrated their efficacy in the long term. Objective: To compare the long-term effectiveness of a program of minimally supervised home RR in relation to the changes in dyspnoea and functional capacity in patients with Chronic Obstructive Pulmonary Disease (COPD). Method: Prospective randomized clinical trial of 1 year duration, with 2 groups: rehabilitation and control. The results of the patients who have completed an inclusion period of 6 months are shown. Two pre-training and post-training variables were measured: dyspnoea by means of Mahler�s basal dyspnoea index (MBDI) and transitional dyspnoea index (TDI), and the exercise capacity by means of the 6 minutes walk test (6MWT). Patients: Individuals with moderate and serious COPD who came to a pneumology consultation and who fulfilled the established criteria of inclusion in a programme of RR. Intervention: The RR group was instructed in a home exercise program with training of the upper and lower limbs. Results: Nineteen patients were evaluated (age 65 ± 6 years and average FEV1 of 39%), which were randomly assigned to each study group: RR group (n = 11) and control group (n = 8). The MBDI was 4.6 in the RR group and 4.75 in the control group. At 6 months the TDI was 3.5 in the RR group and 0.63 in the control group, with differences in all the subscales. The distance covered in the 6MWT increased in both groups, although with a difference of 46 metres in favour of the of RR group. Conclusions: A program of minimally supervised home RR obtains a significant improvement in the dyspnoea and capacity for effort in the patients with COPD. INTRODUCCIÓN: La rehabilitación respiratoria (RR) es una terapia beneficiosa para los enfermos con enfermedad pulmonar obstructiva crónica (EPOC). Sin embargo, la aplicación de la mayoría de los programas diseñados exige un elevado consumo de recursos y pocos han demostrado su eficacia a largo plazo. OBJETIVO: Comparar en pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC) la efectividad a largo plazo de un programa de RR domiciliaria mínimamente supervisado en relación a los cambios en la disnea y capacidad funcional. DISEÑO: Ensayo clínico prospectivo, aleatorizado, de 1 año de duración, con 2 grupos: rehabilitación y control. Se presentan los resultados de los pacientes que han completado un periodo de inclusión de 6 meses. Se midieron pre-entrenamiento y post-entrenamiento dos variables: la disnea mediante el índice de disnea basal de Mahler (IDBM) e índice transicional de disnea (ITD), y la capacidad de ejercicio mediante la prueba de 6 minutos marcha (P6MM). PACIENTES: Individuos con EPOC moderada y grave que acuden a una consulta de Neumología y que cumplen unos criterios establecidos de inclusión en un programa de RR. INTERVENCIÓN: Al grupo de RR se le instruyó en un programa de ejercicio domiciliario con entrenamiento de extremidades superiores e inferiores. RESULTADOS: Se evaluaron 19 sujetos (edad 65 ± 6 años y porcentaje de FEV1 medio de 39%), que se asignaron aleatoriamente a cada grupo de estudio: Grupo RR (n = 11) y grupo control (n = 8). El IDBM fue de 4,6 en el grupo RR y 4,75 en el grupo control. A los 6 meses el ITD fue 3,5 en el grupo RR y 0,63 en el control, con diferencias en todas las subescalas. La distancia recorrida en el 6MWT se incrementó en ambos grupos, aunque con una diferencia de 46 metros a favor del grupo de RR. CONCLUSIONES: Un programa de RR domiciliario y mínimamente supervisado consigue una mejoría significativa en la disnea y en la capacidad de esfuerzo en los pacientes con EPOC
Revista Neumosur, ISSN 0214-6266, Vol. 18, Nº. 2, 2006, pags. 69-77.
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ABSTRACT: ObjetiveTo assess the diagnostic validity, degree of patient satisfaction, and economic cost of home sleep monitoring compared to conventional polysomnography.Patients and methodsConsecutive patients with symptoms indicative of sleep apnea-hypopnea syndrome (SAHS) were included. We analyzed the diagnostic yield of home sleep monitoring using the apnea–hypopnea index (AHI), number of desaturations of at least 3%, and the percentage time with arterial oxygen saturation below 90%. The degree of patient satisfaction, measured on a visual analogue scale, and the cost of home monitoring were compared with conventional polysomnography.ResultsThe study included 52 patients (42 men and 10 women) with a mean (SD) age of 51.8 (9) years and a body mass index of 32 (5) kg/2. Polysomnography and home monitoring revealed an AHI of 33.6 (20) and 31 (19), respectively (r=0.971; intraclass correlation coefficient = 0.963; P<.001). The number of desaturations of at least 3% and the percentage time with arterial oxygen saturation below 90% showed significant correlation and concordance (P<.05). For an AHI cutoff of 10 recorded with polysomnography, home monitoring had a sensitivity of 89% and a specificity of 80%, with an area under the receiver operator characteristic curve of 0.804. For severe SAHS (AHI≥30), the sensitivity and specificity of home monitoring was 100% (that is, the area under the receiver operating characteristic curve was 1). For home monitoring, the cost per diagnostic test was €101.34 less than that of polysomnography, and the patient satisfaction was significantly greater (P<.0001).ConclusionsHome sleep monitoring is a valid and cost-effective diagnostic test; patients with symptoms of SAHS are more satisfied with this technique than conventional polysomnography.ObjetivoComparar la validez diagnóstica, el grado de satisfacción del paciente y el coste económico de la poligrafía domiciliaria respecto a la polisomnografía convencional.Pacientes y métodosSe seleccionó consecutivamente a pacientes con síntomas indicativos de síndrome de apneas hipopneas durante el sueño (SAHS). Analizamos la rentabilidad de la poligrafía domiciliaria mediante el índice apneashipopneas (IAH), el índice de desaturación igual o mayor del 3% y el porcentaje de tiempo con una saturación arterial de oxígeno menor del 90%. Se compararon el grado de satisfacción del paciente, evaluada con una escala visual, y el coste de la poligrafía respecto a la polisomnografía.ResultadosSe incluyó en el estudio a 52 pacientes (42 varones y 10 mujeres) con una edad media ± desviación estándar de 51,8 ± 9 años e índice de masa corporal de 32 ± 5 kg/2. La polisomnografía y la poligrafía obtuvieron un IAH de 33,6 ± 20 y de 31 ± 19, respectivamente (r = 0,971; coeficiente de correlación intraclase = 0,963; p < 0,001). Los valores del índice de desaturación igual o mayor del 3% y el porcentaje de tiempo con una saturación arterial de oxígeno menor del 90% mostraron una correlación y concordancia significativas (p < 0,05). Para un IAH obtenido en la polisomnografía de 10, la poligrafía mostró una sensibilidad del 89% y una especificidad del 80%, con un área bajo la curva de eficacia diagnóstica de 0,804; en el SAHS grave (IAH ≥ 30) la sensibilidad y especificidad de la poligrafía fue del 100% (área bajo la curva de eficacia diagnóstica = 1). En la poligrafía, el coste por prueba diagnóstica fue 101,34 € menor que en la polisomnografía, y el grado de satisfacción del paciente, significativamente mayor (p < 0,0001).ConclusionesLa poligrafía domiciliaria es una técnica diagnóstica válida y coste-eficiente, que aporta mayor grado de satisfacción que la polisomnografía convencional al paciente con síntomas de SAHS.
Archivos de Bronconeumología ((English Edition)).
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ABSTRACT: Background and objectiveLack of adherence to inhaled corticosteroid therapy is common in patients with asthma, and it has been suggested that allowing patients to choose their own inhalers would resolve this problem. The FSI-10 (Feeling of Satisfaction with Inhaler) is a self-completed questionnaire to assess patient opinions regarding ease or difficulty of use, portability, and usability of devices for delivery of inhaled corticosteroids. The aim of this study was to define the measurement properties of the FSI-10 questionnaire and to use this inventory to compare satisfaction and preferences of patients with asthma regarding 3 different devices for delivery of inhaled corticosteroids: Turbuhaler, Accuhaler, and Novolizer.Patients and methodsWe performed a multicenter, prospective, observational study in 112 stable asthmatic patients (64 women; mean [SD] age, 37 [22] years) treated on a regular basis with inhaled corticosteroids. The use of the devices was explained to the patients and the order in which they should be used in each case was randomly assigned. The devices were used for 7-day periods and at the end of each the FSI-10 questionnaire was completed for the device used. Once the protocol was completed, patients stated their preference for the different devices used.ResultsThe FSI-10 was easily understood and rapidly completed, and it exhibited acceptable measurement properties. Factor analysis showed that the measure was unidimensional. Although acceptance of all 3 devices assessed was reasonable, the FSI-10 questionnaire detected significant differences between them: Turbuhaler and Novolizer scored higher than Accuhaler on a number of questions. This preference is partly explained by Turbuhaler having been the device that was commonly used by the patients prior to the study. However, the highest scoring and most often preferred inhaler in patients under 16 years of age was the Novolizer, even though the Turbuhaler had also usually been used by those patients prior to the study.ConclusionsThe FSI-10 is a useful instrument for assessing the degree of satisfaction of asthmatic patients regarding available inhalation devices. It is easy to understand and complete, and able to identify differences in patient satisfaction with the different inhalers.Antecedentes y objetivoEl incumplimiento terapéutico con los corticoides inhalados (CI) es frecuente en los pacientes con asma. Se ha señalado que la elección del dispensador por el paciente facilitaría la solución del problema. El FSI-10 (Evaluación de la Satisfacción con el Inhalador) es un cuestionario autorrellenable que valora las opiniones sobre comodidad, dificultad, transportabilidad y manejabilidad de los dispositivos para CI. El objetivo de este trabajo ha sido definir las propiedades métricas del FSI-10 y comparar, mediante este inventario, la satisfacción y las preferencias de los pacientes con asma respecto a 3 dispositivos para CI: Turbuhaler® (T), Accuhaler® (A) y Novolizer® (N).Pacientes y métodosHemos realizado un estudio observacional, prospectivo y multicéntrico en 112 asmáticos (64 mujeres; edad media ± desviación estándar: 37 ± 22 años) estables y tratados regularmente con CI. Se les explicó la técnica de utilizatión de los dispositivos a evaluar y, aleatoriamente, se asignó el orden en que debían emplearlos. Usaron los dispositivos durante períodos de 7 días, tras los cuales cumplimentaron el FSI-10. Completado el protocolo, todos ellos expresaron el grado de preferencia por los dispositivos empleados.ResultadosEl FSI-10 resultó fácil de comprender y rápido de cumplimentar, y mostró propiedades métricas aceptables. El analisis factorial exploratorio muestra la unidimensionalidad de la medida. La aceptacion de los 3 dispositivos evaluados fue razonable, pero el FSI-10 detect» diferencias signiflcativas entre ellos: los sistemas T y N se valoraron mejor que A en bastantes preguntas del cuestionario. Esta pre-ferencia responde en parte al hecho de que T era el dispositi-vo comunmente utilizado con anterioridad por los pacientes. Sin embargo, para los menores de 16 afios el inhalador prefe-rido y mejor puntuado fue N, a pesar de que en este subgrupo tambien era el T el habitualmente manejado.ConclusionesEl FSI-10 es un instrumento util para evaluar el grado de satisfaction del paciente asmatico con los dispositivos de inhalacion disponibles. Es comprensible, de facil manejo y capaz de identificar diferencias de satisfaccion entre distintos inhaladores.
Archivos de Bronconeumología ((English Edition)).
