Ferran Barbé

Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias, Bunyola, Balearic Islands, Spain

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Publications (140)737.63 Total impact

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    ABSTRACT: There is a bidirectional association between obstructive sleep apnea (OSA) and systemic hypertension. The strengths of this relationship appear to be modulated by factors such as age, sex and somnolence. The 24-hour blood pressure (BP) circadian pattern also appears to be influenced by OSA. Patients with this syndrome exhibit a high prevalence of non-dipping or riser circadian patterns, which are related to clinical and subclinical organ damage in the heart and brain. However, the influence of OSA on nocturnal hypertension development has not yet been clarified. A special area of interest is the recognized relationship between OSA and resistant hypertension. The majority of patients with resistant hypertension suffer OSA. Continuous positive airway pressure (CPAP) treatment significantly reduces BP in such patients and could have a clinical role in the management of BP in these patients. Several meta-analyses have demonstrated a concordant mild effect of CPAP on systemic hypertension. This effect is related with CPAP compliance, somnolence status and baseline BP. The effects of oral appliances on BP in patients with OSA must be evaluated in randomized controlled trials. In the absence of additional data reported by clinical studies on other antihypertensive drug treatments, diuretics, particularly anti-aldosteronic diuretic agents, should be considered the first line antihypertensive drug treatment in patients with OSA. By reducing para-pharyngeal edema and secondary upper airway obstruction, these drugs appear to improve OSA severity and also to reduce BP.
    Chest 04/2015; DOI:10.1378/chest.15-0136 · 7.13 Impact Factor
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    ABSTRACT: To evaluate whether follow-up of patients with obstructive sleep apnoea (OSA) undergoing CPAP treatment could be performed in primary care (PC) settings. Non-inferiority, randomised, prospective controlled study. Sleep unit (SU) at the University Hospital and in 8 PC units in Lleida, Spain. Patients with OSA were randomised to be followed up at the SU or PC units over a 6-month period. The primary outcome was CPAP compliance at 6 months. The secondary outcomes were Epworth Sleep Scale (ESS) score, EuroQoL, patient satisfaction, body mass index (BMI), blood pressure and cost-effectiveness. We included 101 patients in PC ((mean±SD) apnoea-hypopnoea index (AHI) 50.8±22.9/h, age 56.2±11 years, 74% male) and 109 in the SU (AHI 51.4±24.4/h, age 55.8±11 years, 77% male)). The CPAP compliance was (mean (95% CI) 4.94 (4.47 to 5.5) vs 5.23 (4.79 to 5.66) h, p=0.18) in PC and SU groups, respectively. In the SU group, there were greater improvements in ESS scores (mean change 1.79, 95% CI +0.05 to +3.53, p=0.04) and patient satisfaction (-1.49, 95% CI -2.22 to -0.76); there was a significant mean difference in BMI between the groups (0.57, 95% CI +0.01 to +1.13, p=0.04). In the PC setting, there was a cost saving of 60%, with similar effectiveness, as well as a decrease in systolic blood pressure (-5.32; 95% CI -10.91 to +0.28, p=0.06). For patients with OSA, treatment provided in a PC setting did not result in worse CPAP compliance compared with a specialist model and was shown to be a cost-effective alternative. Clinical Trials NCT01918449. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Thorax 04/2015; 70(4):346-352. DOI:10.1136/thoraxjnl-2014-206287 · 8.56 Impact Factor
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    ABSTRACT: We analyze a large population of patients to determine whether gamma glutamyl transferase (GGT) levels are increased in sleep apnea-hypopnea syndrome (OSA) and whether these levels are related to clinical characteristics or polygraphic indexes. A cross-sectional study in a population of 1744 patients referred for OSA suspicion was conducted. The following variables were determined: glucose, cholesterol, triglycerides, aspartate aminotransferase (GOT), alanine aminotransferase (GPT), GGT, body mass index, waist-hip ratio (WHR), and overnight sleep study. The 483 patients with GGT ≥40 IU/l were younger and more obese, and had a pattern of more centrally distributed fat than the 1261 with GGT <40 IU/l. Patients with high levels of GGT also consumed more alcohol, had a poorer biochemical profile, and had more respiratory and oximetric alterations during sleep. GGT levels were significantly correlated with AHI, DI, and CT90. In the binary regression test, WHR, glucose, cholesterol, triglycerides, and grams of alcohol consumed per day predicted GGT levels ≥40 IU/l, while none of the polygraphic variables had predictive value. High GGT levels were associated with the severity of OSA. However, this relationship seems to be due to the coexistence of other associated factors, mainly central obesity, rather than to the respiratory disorders found in this disease.
    Sleep And Breathing 01/2015; DOI:10.1007/s11325-014-1115-5 · 2.87 Impact Factor
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    ABSTRACT: The goal of this study was to evaluate the influence of obstructive sleep apnoea on the severity and short-term prognosis of patients admitted for acute coronary syndrome. Obstructive sleep apnoea was defined as an apnoea-hypopnoea index (AHI) >15 h(-1). We evaluated the acute coronary syndrome severity (ejection fraction, Killip class, number of diseased vessels, and plasma peak troponin) and short-term prognosis (length of hospitalisation, complications and mortality). We included 213 patients with obstructive sleep apnoea (mean±sd AHI 30±14 h(-1), 61±10 years, 80% males) and 218 controls (AHI 6±4 h(-1), 57±12 years, 82% males). Patients with obstructive sleep apnoea exhibited a higher prevalence of systemic hypertension (55% versus 37%, p<0.001), higher body mass index (29±4 kg·m(-2) versus 26±4 kg·m(-2), p<0.001), and lower percentage of smokers (61% versus 71%, p=0.04). After adjusting for smoking, age, body mass index and hypertension, the plasma peak troponin levels were significantly elevated in the obstructive sleep apnoea group (831±908 ng·L(-1) versus 987±884 ng·L(-1), p=0.03) and higher AHI severity was associated with an increased number of diseased vessels (p=0.04). The mean length of stay in the coronary care unit was higher in the obstructive sleep apnoea group (p=0.03). This study indicates that obstructive sleep apnoea is related to an increase in the peak plasma troponin levels, number of diseased vessels, and length of stay in the coronary care unit. Copyright ©ERS 2014.
    European Respiratory Journal 01/2015; 45(2). DOI:10.1183/09031936.00071714 · 7.13 Impact Factor
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    ABSTRACT: This Pulmonary Perspective summarizes the content and main conclusions of an international workshop on personalized respiratory medicine co-organized by the Barcelona Respiratory Network (www.brn.cat) and the AJRCCM in June 2014. It discusses: (1) its definition, historical, social, legal and ethical aspects; (2) the view from different disciplines, including basic science, epidemiology, bioinformatics and network/systems medicine.; (3) the bottlenecks and opportunities identified by some currently ongoing projects; and, (4) the implications for the individual, the health-care system and the pharmaceutical industry. Authors hope that, albeit not a systematic review on the subject, this document can be a useful reference for researchers, clinicians, health-care managers, policy-makers, and industry parties interested in personalized respiratory medicine.
    American Journal of Respiratory and Critical Care Medicine 12/2014; DOI:10.1164/rccm.201410-1935PP · 11.99 Impact Factor
  • Ferran Barbé, Joan Escarrabill
    Archivos de Bronconeumología 12/2014; DOI:10.1016/j.arbres.2013.11.020 · 1.82 Impact Factor
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    ABSTRACT: Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored.
    Sleep 10/2014; · 5.06 Impact Factor
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    ABSTRACT: Abstract This paper deals with the potential and limitations of using voice and speech processing to detect Obstructive Sleep Apnea (OSA). An extensive body of voice features has been extracted from patients who present various degrees of OSA as well as healthy controls. We analyse the utility of a reduced set of features for detecting OSA. We apply various feature selection and reduction schemes (statistical ranking, Genetic Algorithms, PCA, LDA) and compare various classifiers (Bayesian Classifiers, kNN, Support Vector Machines, neural networks, Adaboost). S-fold crossvalidation performed on 248 subjects shows that in the extreme cases (that is, 127 controls and 121 patients with severe OSA) voice alone is able to discriminate quite well between the presence and absence of OSA. However, this is not the case with mild OSA and healthy snoring patients where voice seems to play a secondary role. We found that the best classification schemes are achieved using a Genetic Algorithm for feature selection/reduction.
    Applied Soft Computing 10/2014; 23:346 - 354. DOI:10.1016/j.asoc.2014.06.017 · 2.68 Impact Factor
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    ABSTRACT: Study Objectives: Obstructive sleep apnea (OSA) diagnosis using simplified methods such as portable sleep monitoring (PM) is only recommended in patients with a high pretest probability. The aim is to determine the diagnostic efficacy, consequent therapeutic decision-making, and costs of OSA diagnosis using polysomnography (PSG) versus three consecutive studies of PM in patients with mild to moderate suspicion of sleep apnea or with comorbidity that can mask OSA symptoms. Design and Setting: Randomized, blinded, crossover study of 3 nights of PM (3N-PM) versus PSG. The diagnostic efficacy was evaluated with receiver operating characteristic (ROC) curves. Therapeutic decisions to assess concordance between the two different approaches were performed by sleep physicians and respiratory physicians (staff and residents) using agreement level and kappa coefficient. The costs of each diagnostic strategy were considered. Patients and Results: Fifty-six patients were selected. Epworth Sleepiness Scale was 10.1 (5.3) points. Bland-Altman plot for apnea-hypopnea index (AHI) showed good agreement. ROC curves showed the best area under the curve in patients with PSG AHI >= 5 [0.955 (confidence interval = 0.862-0.993)]. For a PSG AHI = 5, a PM AHI of 5 would effectively exclude and confirm OSA diagnosis. For a PSG AHI = 15, a PM AHI = 22 would confirm and PM AHI <7 would exclude OSA. The best agreement of therapeutic decisions was achieved by the sleep medicine specialists (81.8%). The best cost-diagnostic efficacy was obtained by the 3N-PM. Conclusions: Three consecutive nights of portable monitoring at home evaluated by a qualified sleep specialist is useful for the management of patients without high pretest probability of obstructive sleep apnea or with comorbidities.
    Sleep 08/2014; 37(8):1363-73. DOI:10.5665/sleep.3932 · 5.06 Impact Factor
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    ABSTRACT: Objective The association between obstructive sleep apnea (OSA) and cancer mortality has scarcely been studied. The objective of this study was to investigate whether OSA is associated with increased cancer mortality in a large cohort of patients with OSA suspicion. Methods This was a multicenter study in consecutive patients investigated for suspected OSA. OSA severity was measured by the apnea–hypopnea index (AHI) and the hypoxemia index (% night-time spent with oxygen saturation <90%, TSat90). The association between OSA severity and cancer mortality was assessed using Cox’s proportional regression analyses after adjusting for relevant confounders. Results In all, 5427 patients with median follow-up of 4.5 years were included. Of these, 527 (9.7%) were diagnosed with cancer. Log-transformed TSat90 was independently associated with increased cancer mortality in the entire cohort (hazard ratio [HR], 1.21; 95% confidence interval [CI], 1.03–1.42), as well as in the group of patients with cancer (HR, 1.19; 95% CI, 1.02–1.41). The closest association was shown in patients <65 years in both the AHI (continuous log-transformed AHI, HR, 1.87; 95% CI, 1.1–3.2; upper vs lower AHI tertile, HR, 3.98; 95% CI, 1.14–3.64) and the TSat90 (continuous log-transformed TSat90: HR, 1.73; 95% CI, 1.23–2.4; upper vs lower TSat90 tertile: HR, 14.4; 95% CI, 1.85–111.6). Conclusions OSA severity was associated with increased cancer mortality, particularly in patients aged <65 years.
    Sleep Medicine 07/2014; 15(7). DOI:10.1016/j.sleep.2014.01.020 · 3.10 Impact Factor
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    ABSTRACT: Background CPAP reduces blood pressure (BP) in patients with symptomatic obstructive sleep apnoea (OSA). Whether the same benefit is present in patients with minimally symptomatic OSA is unclear, thus a meta-analysis of existing trial data is required. Methods The electronic databases Medline, Embase and trial registries were searched. Trials were eligible if they included patients with minimally symptomatic OSA, had randomised them to receive CPAP or either sham-CPAP or no CPAP, and recorded BP at baseline and follow-up. Individual participant data were obtained. Primary outcomes were absolute change in systolic and diastolic BP. Findings Five eligible trials were found (1219 patients) from which data from four studies (1206 patients) were obtained. Mean (SD) baseline systolic and diastolic BP across all four studies was 131.2 (15.8) mm Hg and 80.9 (10.4) mm Hg, respectively. There was a slight increase in systolic BP of 1.1 mm Hg (95% CI −0.2 to 2.3, p=0.086) and a slight reduction in diastolic BP of 0.8 mm Hg (95% CI −1.6 to 0.1, p=0.083), although the results were not statistically significant. There was some evidence of an increase in systolic BP in patients using CPAP <4 h/night (1.5 mm Hg, 95% CI −0.0 to 3.1, p=0.052) and reduction in diastolic BP in patients using CPAP >4 h/night (−1.4 mm Hg, 95% CI −2.5 to −0.4, p=0.008). CPAP treatment reduced both subjective sleepiness (p<0.001) and OSA severity (p<0.001). Interpretation Although CPAP treatment reduces OSA severity and sleepiness, it seems not to have a beneficial effect on BP in patients with minimally symptomatic OSA, except in patients who used CPAP for >4 h/night.
    Thorax 06/2014; 69(12). DOI:10.1136/thoraxjnl-2013-204993 · 8.56 Impact Factor
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    ABSTRACT: Objective Obstructive sleep apnea (OSA) has been associated with metabolic disorders. Sleep-disordered breathing could generate an altered rhythm in the expression of metabolic hormones, which could predispose to metabolic disorders. The aim of this study was to evaluate the effect of sleep apnea on diurnal variations in metabolic hormones. Methods Thirty-seven male, newly diagnosed, patients with OSA with an apnea–hypopnea index (AHI) ⩾20/h and 11 male controls (AHI <10/h) matched for body mass index (±3 kg/m2) were included. Six different samples were obtained from each subject during a period of 24 h. Levels of the metabolic hormones ghrelin, leptin, resistin, and adiponectin were measured in plasma by immunoassay. Results Patients with OSA (AHI (mean ± SD) 46 ± 26/h) were older than the controls (42 ± 9 vs 33 ± 9 years, P = 0.01). Differences in metabolic hormones between groups did not reach statistical significance at any point in the evaluation. No significant differences were observed in the area under the curve for any of the hormones analysed. Likewise, we did not detect diurnal variations in metabolic hormones. Conclusions The results of this study indicate that the day–night variations in the levels of several metabolic hormones are not influenced by the presence of sleep apnea.
    Sleep Medicine 06/2014; 15(6). DOI:10.1016/j.sleep.2014.03.007 · 3.10 Impact Factor
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    ABSTRACT: Obstructive sleep apnea (OSA) is associated with an increased prevalence of cardiovascular diseases. New generations of highly sensitive assays for cardiac troponin (hs-cTnT) have been introduced recently, and a number of clinical observations have challenged the notion that troponins are only increased in blood following irreversible necrosis. The aims of this study were to compare the levels of hs-cTnT between a group of healthy controls and a group of patients with OSA without co-existent coronary artery disease, and to assess the possible influence of the treatment with Continuous positive airway pressure (CPAP) on these levels. The study population included 200 male participants. The case (n = 133) or control (n = 67) status was defined by an apnea-hypopnea index of 10 or greater. The hs-cTnT assay was validated as reported previously, with a limit of detection of 3 ng/L and an upper reference limit (99th percentile) of 14 ng/L. The proportion of subjects with detectable plasma hs-cTnT was higher in patients with OSA than in controls (61 vs 75%, p = 0.04). In patients, a significant increase in hs-cTnT levels was observed after an effective treatment with CPAP (7.3 ± 3.4 vs 10.1 ± 4.9 ng/L; p < 0.01). This study shows that the percentage of subjects with detectable hs-cTnT is associated with the presence of OSA. It also evidences that treatment with CPAP is followed by a rise in hs-cTnT concentrations. It is reasonable to suggest that CPAP therapy might induce a potential degree of cardiac stress, resulting in deleterious consequences for the heart.
    Respiratory medicine 04/2014; 108(7). DOI:10.1016/j.rmed.2014.04.005 · 2.92 Impact Factor
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    ABSTRACT: Obstructive sleep apnoea (OSA) is associated with increased risk of dysglycaemia but the intimate link of these conditions with obesity makes discerning an independent relationship between them challenging. Glycosylated haemoglobin (HbA1c) levels predict adverse cardiovascular outcomes in nondiabetics but there is a lack of population-level data exploring the relationship of HbA1c with OSA.A cross-sectional analysis of 5294 participants in the multinational European Sleep Apnoea Cohort (European Sleep Apnoea Database) study was performed, assessing the relationship of OSA severity with HbA1c levels in nondiabetic subjects, with adjustment for confounding factors.HbA1c levels correlated significantly with OSA severity in univariate analysis. Following adjustment for confounding factors, apnoea-hypopnoea index (AHI) (standardised β 0.158; p<0.001), along with nocturnal hypoxaemia, predicted HbA1c. Adjusted mean HbA1c levels were lower in the lowest AHI quartile (5.24%, 95% CI 5.21-5.27%) than in the second (5.37%, 95% CI 5.34-5.40%), third (5.44%, 95% CI 5.41-5.47%) or highest (5.50%, 95% CI 5.46-5.53%) quartiles. Subjects in the higher quartiles had significantly greater adjusted odds ratios of HbA1c level ≥6.0% than those in the first quartile. In stratified analyses, OSA severity predicted glycaemic health irrespective of sleep study modality, sex, obesity or daytime sleepiness.OSA severity independently predicts glycaemic health in nondiabetic subjects. Further studies should assess the impact of OSA treatment on glycaemic health and elucidate underlying mechanisms.
    European Respiratory Journal 04/2014; DOI:10.1183/09031936.00162713 · 7.13 Impact Factor
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    ABSTRACT: OSA PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Home single-channel nasal pressure (HNP) may be an alternative to polysomnography (PSG) for obstructive sleep apnea (OSA) diagnosis but no cost studies have 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 a clinical-epidemiological apnea-hypopnea index (AHI) cut-off point (≥5) and a clinical-therapeutic AHI cut-off point (≥15). 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 cut-off points and costs were calculated for equally effective alternatives. Of 787 randomized patients, 752 underwent HNP. Manual scoring produced better ROC curves than automatic for AHI≥5 and similar for AHI≥15. A valid HNP would correctly classify the OSA presence (or otherwise) with manual scoring for a clinical-epidemiological diagnosis in 90% of patients and with automatic scoring for a clinical-therapeutic diagnosis in 60%. The costs of either HNP approach were 40%-70% lower than those of PSG. Manual HNP for clinical-epidemiological diagnosis had the lowest cost and manual and automatic scorings had similar costs for clinical-therapeutic diagnosis. HNP is a cheaper alternative than PSG for OSA diagnosis. Manual HNP scoring seems especially useful for epidemiological studies on a clinical population base, although manual or automatic scorings can achieve a suitable diagnosis for clinical-therapeutic management The use of a very simple automatic device favor the use for non-specialist practitioners for the management of patients with sleep apnea suspicion The following authors have nothing to disclose: Juan F. Masa, Joaquín Durán-Cantolla, Francisco Capote, Marta Cabello, Jorge Abad, Francisco Garcia-Rio, Antoni Ferrer, Merche Mayos, Nicolás Mangado, Mónica de la Peña, Felipe Aizpuru, Ferran Barbé, Jose M. MontserratNo Product/Research Disclosure Information.
    Chest 03/2014; 145(3 Suppl):592A. DOI:10.1378/chest.1776063 · 7.13 Impact Factor
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    ABSTRACT: Metabolic syndrome (MS) occurs frequently in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). We hypothesized that aldosterone levels are elevated in OSAHS and associated with the presence of MS. We studied 66 patients with OSAHS (33 with MS and 33 without MS) and 35 controls. The occurrence of the MS was analyzed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) clinical criteria. Measurements of plasma renin activity (PRA), aldosterone, aldosterone:PRA ratio, creatinine, glucose, triglycerides, cholesterol and HDL cholesterol were obtained at baseline and after CPAP treatment. Aldosterone levels were associated with the severity of OSAHS and higher than controls (p = 0.046). Significant differences in aldosterone levels were detected between OSAHS patients with and without MS (p = 0.041). A significant reduction was observed in the aldosterone levels in patients under CPAP treatment (p = 0.012). This study shows that aldosterone levels are elevated in OSAHS in comparison to controls, and that CPAP therapy reduces aldosterone levels. It also shows that aldosterone levels are associated with the presence of metabolic syndrome, suggesting that aldosterone excess might predispose or aggravate the metabolic and cardiovascular complications of OSAHS. The study is not a randomized controlled trial and was not registered.
    PLoS ONE 01/2014; 9(1):e84362. DOI:10.1371/journal.pone.0084362 · 3.53 Impact Factor
  • Ferran Barbé, Joan Escarrabill
    Archivos de Bronconeumología 01/2014; · 2.17 Impact Factor
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    ABSTRACT: NTRODUCTION: 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.
    Sleep 01/2014; 37(12):1953. DOI:10.5665/sleep.4248 · 5.06 Impact Factor
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    ABSTRACT: We sought to perform a patient-level meta-analysis using the individual patient data of the trials identified in our previous study-level meta-analysis investigating the effect of positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) on blood pressure (BP). Patient-level meta-analysis. N/A. 968 adult OSA subjects without major comorbidities drawn from eight randomized controlled trials. Therapeutic PAP versus non-therapeutic control conditions (sham-PAP, pill placebo or standard care) over at least one week. The mean reductions in BP between PAP and non-therapeutic control arms were -2.27 mm Hg (95% CI -4.01 to -0.54) for systolic BP and -1.78 mm Hg (95% CI -2.99 to -0.58) for diastolic BP. The presence of uncontrolled hypertension at baseline was significantly associated with a reduction in systolic BP of 7.1 mm Hg and diastolic BP of 4.3 mm Hg after controlling for OSA severity (apnea-hypopnea index, Epworth Sleepiness Scale score, PAP level), patient demographics (age, gender, body mass index, use of antihypertensive medication/s), and measures of PAP efficacy (PAP adherence and treatment duration). OSA patients with uncontrolled hypertension are likely to gain the largest benefit from PAP in terms of a substantial reduction in BP, even after controlling for disease severity. Bakker JP; Edwards BA; Gautam SP; Montesi SB; Durán-Cantolla J; Barandiarán FA; Barbé F; Sánchezde-la-Torre M; Malhotra A. Blood pressure improvement with continuous positive airway pressure is independent of obstructive sleep apnea severity. J Clin Sleep Med 2014;10(4):365-369.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2014; 10(4):365-9. DOI:10.5664/jcsm.3604 · 2.83 Impact Factor
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    ABSTRACT: There is compelling evidence that obstructive sleep apnoea (OSA) can affect metabolic syndrome (MetS) and cardiovascular risk, but the intermediate mechanisms through which it occurs have not been well defined. We explored the impact of OSA in morbidly obese patients with MetS on adipokines, pro-inflammatory markers, endothelial dysfunction, and atherosclerosis markers. We included 52 morbidly obese patients in an observational study matched for age, gender and central obesity in 3 groups (OSA-MetS, Non-OSA-MetS, and Non OSA-non-MetS). Anthropometrical, blood pressure, and fasting blood measurements were obtained the morning after an overnight polysomnography. VEGF, soluble CD40 ligand (sCD40L), TNF-α, IL-6, leptin, adiponectin, and chemerin were determined in serum by ELISA. OSA was defined as apnea/ hypopnea index ≥ 15 and MetS by NCEP-ATP III. Cases and control subjects did not differ in age, BMI, waist circumference, and gender (43 ± 10 years, 46 ± 5 kg/m(2), 128 ± 10 cm, 71% females). The cases had severe OSA with 47 (32-66) events/h, time spent < 90% SpO2 7% (5%-31%). All groups presented similar serum cytokines, adipokines, VEGF, and sCD40L levels. In a morbidly obese population with established MetS, the presence of OSA did not determine any differences in the studied mediators when matched by central obesity. Morbidly obese NonOSA-NonMetS had a similar inflammatory, adipokine VEGF, and sCD40L profile as those with established MetS, with or without OSA. Obesity itself could overwhelm the effect of sleep apnea and MetS in the studied biomarkers. Salord N; Gasa M; Mayos M; Fortuna-Gutierrez AM; Montserrat JM; Sánchez-de-la-Torre M; Barceló A; Barbé F; Vilarrasa N; Monasterio C. Impact of OSA on biological markers in morbid obesity and metabolic syndrome. J Clin Sleep Med 2014;10(3):263-270.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2014; 10(3):263-70. DOI:10.5664/jcsm.3524 · 2.83 Impact Factor

Publication Stats

3k Citations
737.63 Total Impact Points

Institutions

  • 2011–2015
    • Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias
      Bunyola, Balearic Islands, Spain
    • Universitat de Lleida
      Lérida, Catalonia, Spain
    • Hospital Universitari Son Espases
      Palma, Balearic Islands, Spain
  • 2007–2015
    • Hospital Universitari Arnau de Vilanova
      Lérida, Catalonia, Spain
    • University of Louisville
      Louisville, Kentucky, United States
    • Hospital Clínic de Barcelona
      • Servicio de Neumología
      Barcino, Catalonia, Spain
  • 2009–2014
    • IRB Lleida Biomedical Research Institute of Lleida
      Lérida, Catalonia, Spain
    • Hospital Universitario San Juan De Alicante
      Alicante, Valencia, Spain
  • 2007–2014
    • Hospital Arnau de Vilanova
      Valenza, Valencia, Spain
  • 2005–2014
    • San Pedro Hospital
      Central, Davao, Philippines
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 2010–2012
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
  • 1993–2009
    • Hospital Son Dureta
      Palma, Balearic Islands, Spain
  • 1996–2007
    • University of the Balearic Islands
      Palma, Balearic Islands, Spain
  • 2001–2006
    • Hospital de Txagorritxu
      Vitoria, Basque Country, Spain