Jose M Marin

Hospital Universitario Miguel Servet, Caesaraugusta, Aragon, Spain

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Publications (69)376.16 Total impact

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    ABSTRACT: Purpose: To evaluate the outcomes of standard automated perimetry (SAP) in patients with obstructive sleep apnea (OSA). Methods: Eighty OSA patients and 111 age-matched controls were consecutively and prospectively enrolled. One eye per subject was randomly selected. All participants underwent at least one reliable SAP (24-2 SITA standard algorithm). The peripapillary retinal nerve fiber layer thickness (RNFL) was measured with spectral-domain optical coherence tomography (OCT). OSA patients were classified into three groups according to the apnea/hypopnea index: mild, moderate, or severe OSA. SAP and OCT parameters were compared between healthy controls and OSA patients. Correlation of apnea/hypopnea index with OCT and SAP measurements were calculated. Results: Mean age, best-corrected visual acuity, and central corneal thickness were similar between groups. Intraocular pressure, however, was lower in the OSA group. Mean deviation of SAP was -0.23 ± 0.8 dB in the control group and -1.74 ± 2.8 dB in the OSA group (p<0.001). RNFL thickness measured with OCT did not differ significantly between groups. Patients with OSA showed reduced sensitivity at most points tested by white-on-white perimetry compared with healthy individuals. The threshold values were more depressed in the peripheral visual field. The apnea/hypopnea index was related to the SAP indices: Pearson correlations were -0.432 with mean deviation, 0.467 with pattern standard deviation, and -0.416 with the visual field index (p<0.001). Conclusions: OSA patients exhibited reduced retinal sensitivity measured with SAP compared to healthy controls.
    Investigative ophthalmology & visual science. 10/2014;
  • Jose M. Marin
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    ABSTRACT: Obstructive sleep apnoea (OSA) is defined as the presence of more than five events of complete obstruction (apnoea) or partial obstruction (hypopnea) of the pharynx [apnoea–hypopnaea index (AHI) >5] per hour of sleep. Among adults, more than 24% of men and 9% of women suffer from OSA each night [1]. When a patient with OSA presents daytime sleepiness that affects work or social activity, OSA syndrome is diagnosed. Almost all patients with OSA snore and experience unrefreshed sleep but tend not to consult their general practitioner (GP) regarding this symptomatology.This article is protected by copyright. All rights reserved.
    Journal of Internal Medicine 08/2014; · 6.46 Impact Factor
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    ABSTRACT: Obstructive sleep apnea (OSA) is associated with increased risk for cardiovascular morbidity and mortality. Epidemiological and animal models studies generate hypotheses for innovative strategies in OSA management by interfering intermediates mechanisms associated with cardiovascular complications. We have thus initiated the Epigenetics modification in Obstructive Sleep Apnea (EPIOSA) study (ClinicalTrials.gov identifier: NCT02131610).
    BMC Pulmonary Medicine 07/2014; 14(1):114. · 2.76 Impact Factor
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    ABSTRACT: The Global Obstructive Lung Disease (GOLD) 2011 revision recommends the multidimensional assessment of COPD including comorbidities and has developed a disease categories system (ABCD) attempting to implement this strategy. The added value provided by quantifying comorbidities and integrating them to multidimensional indices has not been explored.
    Thorax 06/2014; · 8.38 Impact Factor
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    ABSTRACT: Pulmonary and Sleep MedicineSESSION TYPE: Slide PresentationPRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AMPURPOSE: Intermittent hypoxia and increase sympathetic activity during apnea episodes may cause systemic inflammation via down-regulation of regulatory T-cell (Treg cells). This may contribute to premature atherosclerosis leading to an increase in the size of arterial intima-media thickness (IMT). To evaluate the relationship between Treg plasma cells and intima-media thickness (IMT) in non-OSA and OSA patients without comorbidities During a 10 months period, we enrolled 100 adults (age range: 20 to 55) among those referred for sleep study due to suspected OSA. Exclusion criteria were: history of tobacco or alcohol consumption, hypertension, dyslipidemia, diabetes, cardiovascular, cerebrovascular, renal, neuromuscular, inflammatory or autoimmune chronic diseases. OSA diagnosis was made on the basis of an apnea/hypopnea index (AHI) > 5. IMT was assessed in common carotid arteries by high-resolution B-mode ultrasonography. By flow-cytometry analysis, CD+CD25+Foxp3+ cells as were acquired (BD Pharmigen) and identified as Treg cells. Non-OSA subjects (n = 30) were younger (41 ± 8 vs 45 ± 8 years, p = 0.02) and had a lower body mass index (26.4 ± 3.8 vs 30.1 ± 5.5 kg/m2, p < 0.001) than OSA patients (n = 70). IMT was 0.53 ± 0.08 (95 percentile: 0.65 mm) and 0.66 ± 0.12 mm respectively (p<0.001). Abnormal IMT (> 0.65 mm) was identified in 41% of OSA group. In multivariate linear regression analyses, age, BMI and baseline systolic blood pressure but not AHI, were related with IMT. Treg cells represent 7.5 ± 1.6% of all CD3 (lymphocytes) in non-OSA subjects and 6.7 ± 1.4 % in OSA patients. IMT and Treg cells were significantly related (r = -0.29, p =0.007). Down regulation of Treg cells but not AHI is associated with subclinical atherosclerosis suggesting different epigenetic adaptations to apnea episodes in OSA. The effect of nocturnal intermittent hypoxia and increase sympathetic activity is not homogeneous among all patients with OSA. It seems that a subset of patients exhibit an increased risk of subclinical atherosclerosis associated with a down-regulation of regulatory T-cells. This subgroup of patients probably represents a particular phenotypic presentation of OSA that merits a specific treatment. Supported by ISCIII grant PI12/02175 and SEPAR-2014DISCLOSURE: The following authors have nothing to disclose: Marta Marin-Oto, Teresa Martin, Javier Godino, Marta Andres, Victoria Gil, Jose MarinNo Product/Research Disclosure Information.
    Chest 03/2014; 145(3 Suppl):609C. · 7.13 Impact Factor
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    ABSTRACT: ABSTRACT RATIONALE: The Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was proposed for assessing health status in COPD, but little is known about its longitudinal changes. OBJECTIVE: To evaluate one-year CAT variability in stable COPD patients and relate its variations to changes in other disease markers. METHODS: We evaluated the following variables in smokers with and without COPD at baseline and after one year: CAT score, age, gender, smoking status, pack-years history, BMI, modified Medical Research Council (MMRC) scale, 6MWD, lung function, BODE index, hospital admissions, Hospital and Depression Questionnaire, and the Charlson comorbidity score. In COPD patients we explored the association of CAT scores and its one-year changes with the studied parameters. RESULTS: 824 smokers with COPD and 126 without were evaluated at baseline, and 441 smokers with COPD and 66 without one year later. At 1 year, CAT scores for COPD patients were similar (±4 points) in 56%, higher in 27%, and lower in 17%. Interestingly, MMRC scores were similar (± 1 point) in 46% of patients, worse in 36% and better in 18% at 1 year. One-year CAT changes were best predicted by changes in MMRC scores (β coefficient 0.47, p<0.001). A similar behavior was found for CAT and MMRC in smokers without COPD. CONCLUSIONS: One-year longitudinal data shows variability in CAT scores among stable COPD patients, similar to what happened to MMRC that was the best predictor of one-year CAT changes. Further longitudinal studies should confirm the long-term CAT variability and it clinical applicability.
    Chest 02/2014; · 7.13 Impact Factor
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    ABSTRACT: Rationale: Little is known about the longitudinal changes associated with using the 2013 update of the multidimensional GOLD strategy for chronic obstructive pulmonary disease (COPD). To determine the COPD patient distribution of the new GOLD proposal and evaluate how this classification changes over one year compared with the previous GOLD staging based on spirometry only. We analyzed data from the CHAIN study, a multicenter observational Spanish cohort of COPD patients who are monitored annually. Categories were defined according to the proposed GOLD: FEV1%, mMRC dyspnea, COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), and exacerbations-hospitalizations. One-year follow-up information was available for all variables except CCQ data. At baseline, 828 stable COPD patients were evaluated. On the basis of mMRC dyspnea versus CAT, the patients were distributed as follows: 38.2% vs. 27.2% in group A, 17.6% vs. 28.3% in group B, 15.8% vs. 12.9% in group C, and 28.4% vs. 31.6% in group D. Information was available for 526 patients at one year: 64.2% of patients remained in the same group but groups C and D show different degrees of variability. The annual progression by group was mainly associated with one-year changes in CAT scores (RR, 1.138; 95%CI: 1.074-1.206) and BODE index values (RR, 2.012; 95%CI: 1.487-2.722). In the new GOLD grading classification, the type of tool used to determine the level of symptoms can substantially alter the group assignment. A change in category after one year was associated with longitudinal changes in the CAT and BODE index.
    Respiratory research 01/2014; 15(1):3. · 3.64 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. 01/2014;
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    ABSTRACT: Background The forced expiratory volume at first second (FEV1) during spirometry reflects the severity of Chronic Obstructive Pulmonary Disease (COPD) and is known to be an important prognostic factor. It is uncertain whether the response to short-acting bronchodilators may predict long-term outcomes such as hospitalizations and mortality. Methods We retrospectively studied a total of 1203 consecutive COPD patients without significant co-morbidities during a mean (±SD) of 69±39 months of follow-up. At baseline the subjects were classified as those with positive or negative bronchodilator test (BDT) and also in quartiles of absolute bronchodilator response to 400 μg of salbutamol. Hospital visits and mortality were the end points. Results A positive bronchodilator test was observed in 332 (27.6%) of the patients. There were 73 (21.9%) deaths in patients with a positive BDT versus 253 (28.7%) in those with a negative BDT (p=0.04). In adjusted Cox regression analysis a positive BDT was significantly associated with a prolonged time to first hospitalization. After stratifying the population by quartiles of response to BDT, a dose-response relationship was observed with the best outcomes in the quartile with highest level of airflow reversibility, even after controlling for age, sex, BMI, smoking status and baseline postbronchodilator FEV1 Conclusions In a large population of well characterized COPD patients without significant comorbidities, those demonstrating higher levels of reversibility at baseline presented better long-term outcomes even after controlling for other known prognostic factors.
    Respiratory Medicine. 01/2014;
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    ABSTRACT: FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence. We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients. We conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival. A total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.4±9.7, and predicted FEV1 of 53.8% (±19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild ≥70%, moderate 56-69%, severe 36-55%, and very severe ≤35%. Survival at 5 years was 0.89 for patients with FEV1≥70 vs. 0.46 in patients with FEV1 ≤35% (H.R: 6; 95% C.I.: 4.69-7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear. The best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by ≥70%, 56-69%, 36-55%, and ≤35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs.
    PLoS ONE 01/2014; 9(2):e89866. · 3.53 Impact Factor
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    ABSTRACT: Sleep in chronic obstructive pulmonary disease (COPD) is commonly associated with oxygen desaturation, which may exceed the degree of desaturation during maximum exercise, both subjectively and objectively impairing sleep quality. The mechanisms of desaturation include hypoventilation and ventilation to perfusion mismatching. The consequences of this desaturation include cardiac arrhythmias, pulmonary hypertension and nocturnal death, especially during acute exacerbations. Coexistence of COPD and obstructive sleep apnoea (OSA), referred to as overlap syndrome, has been estimated to occur in 1% of the general adult population. Overlap patients have worse sleep-related hypoxaemia and hypercapnia than patients with COPD or OSA alone. OSA has a similar prevalence in COPD as in a general population of similar age, but oxygen desaturation during sleep is more pronounced when the two conditions coexist. Management of sleep-related problems in COPD should particularly focus on minimising sleep disturbance via measures to limit cough and dyspnoea; nocturnal oxygen therapy is not generally indicated for isolated nocturnal hypoxaemia. Treatment with continuous positive airway pressure alleviates hypoxaemia, reduces hospitalisation and pulmonary hypertension, and improves survival.
    European Respiratory Review 09/2013; 22(129):365-75.
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    ABSTRACT: BACKGROUND: COPD is an independent risk factor for lung cancer, especially in patients with mild to moderate disease. OBJECTIVE: To determine if performing lung cancer screening in GOLD 1 and 2 COPD patients, results in reduced lung cancer mortality. METHODS: This study compared patients with mild to moderate COPD from 2 cohorts matched for age, gender, BMI, FEV1%, pack-yrs history and smoking status. The screening group (SG) had an annual low dose computed tomography (LDCT). The control group (CG) was prospectively followed with usual care. Lung cancer incidence and mortality densities were compared between groups. RESULTS: From an initial sample of 410 (SG) and 735 (CG) patients we were able to match 333 patients from each group. At the same follow-up time lung cancer incidence density was 1.79/100 person-years in the SG and 4.14/100 person-years in the CG (p = 0.004). The most frequent histological type was adenocarcinoma in both SG and CG (65% and 46%, respectively), followed by squamous cell carcinoma (25% and 37%, respectively). Eighty percent of lung cancers in the SG (16/20) were diagnosed in stage I, and all of CG cancers (35/35) were in stage III or IV. Mortality incidence density from lung cancer (0.08 vs. 2.48/100 person-years, p < 0.001) was lower in the SG. CONCLUSIONS: This pilot study in patients with mild to moderate COPD suggests that screening with LDCT detects lung cancer in early stages, and could decrease lung cancer mortality in that high risk group. Appropriately designed studies should confirm these important findings.
    Respiratory medicine 02/2013; · 2.33 Impact Factor
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    ABSTRACT: Guidelines recommend to define COPD by airflow obstruction and other factors, but no studies evaluated the ability of existing multicomponent indices to predict mortality up to 10 years.We conducted a patient-based pooled analysis. Survival analysis and C-statistics were used to determine the best COPD index/indices according to several construct variables and by varying time points. Individual data of 3,633 patients from eleven COPD cohorts were collected, totalling the experience of 15,878 person-years.Overall, there were 1,245 death events within our cohorts, with a K-M survival of 0.963 at 6-months, down to 0.432 at 10 years. In all patients, ADO, BODE and e-BODE were the best indices to predict 6-months mortality. The ADO index was the best to predict 12-month mortality (C-statistic 0.702), 5-yr mortality (C-statistic 0.695), and 10-yr mortality (C-statistic 0.698), significantly better than BODE (all p<0.05). The best indices to predict death by C-statistics when adjusting by age were eBODE, BODEx, and BODE.No index predicts well short-term survival. All BODE modifications score better than ADO after age adjustment.. The ADO and BODE indices are overall the most valid multicomponent indices to predict time to death in all COPD patients.
    European Respiratory Journal 12/2012; · 6.36 Impact Factor
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    ABSTRACT: IntroductionThis present paper describes the method and the organization of the study known as the COPD History Assessment In SpaiN (CHAIN), whose main objective is to evaluate the long-term natural history of a chronic obstructive pulmonary disease (COPD) patient cohort from a multidimensional standpoint and to identify clinical phenotypes, in comparison with another non-COPD control cohort.Patients and methodsCHAIN is a multicenter, observational study of prospective cohorts carried out at 36 Spanish hospitals. Both cohorts will be followed-up during a 5-year study period with complete office visits every 12 months and telephone interviews every 6 months in order to evaluate exacerbations and the vital state of the subjects. The recruitment period for cases was between 15 January 2010 and 31 March 2012. At each annual visit, information will be collected on: (i) clinical aspects (socio-economic situation, anthropometric data, comorbidities, smoking, respiratory symptoms, exacerbations, quality of life, anxiety-depression scale, daily life activities, treatments); (ii) respiratory function (spirometry, blood gases, hyperinflation, diffusion, respiratory pressures); (iii) BODE index (main study variable); (iv) peripheral muscle function, and (v) blood work-up (including IgE and cardiovascular risk factors). In addition, a serum bank will be created for the future determination of biomarkers. The data of the patients are anonymized in a database with a hierarchical access control in order to guarantee secure information access. The CHAIN study will provide information about the progression of COPD and it will establish a network of researchers for future projects related with COPD.
    Archivos de Bronconeumología 12/2012; 48(12):453–459. · 2.17 Impact Factor
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    ABSTRACT: IntroductionThis present paper describes the method and the organization of the study known as the COPD History Assessment In SpaiN (CHAIN), whose main objective is to evaluate the long-term natural history of a chronic obstructive pulmonary disease (COPD) patient cohort from a multidimensional standpoint and to identify clinical phenotypes, in comparison with another non-COPD control cohort.Patients and methodsCHAIN is a multicenter, observational study of prospective cohorts carried out at 36 Spanish hospitals. Both cohorts will be followed-up during a 5-year study period with complete office visits every 12 months and telephone interviews every 6 months in order to evaluate exacerbations and the vital state of the subjects. The recruitment period for cases was between 15 January 2010 and 31 March 2012. At each annual visit, information will be collected on: (i) clinical aspects (socio-economic situation, anthropometric data, comorbidities, smoking, respiratory symptoms, exacerbations, quality of life, anxiety-depression scale, daily life activities, treatments); (ii) respiratory function (spirometry, blood gases, hyperinflation, diffusion, respiratory pressures); (iii) BODE index (main study variable); (iv) peripheral muscle function, and (v) blood work-up (including IgE and cardiovascular risk factors). In addition, a serum bank will be created for the future determination of biomarkers. The data of the patients are anonymized in a database with a hierarchical access control in order to guarantee secure information access. The CHAIN study will provide information about the progression of COPD and it will establish a network of researchers for future projects related with COPD.ResumenIntroducciónEl presente trabajo describe el método y la organización del trabajo del estudio COPD History Assessment in SpaiN (CHAIN), cuyo objetivo principal es evaluar a largo plazo la historia natural de una cohorte de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) desde un punto de vista multidimensional y la identificación de fenotipos clínicos comparándola con otra cohorte control sin EPOC.Pacientes y métodoCHAIN es un estudio observacional multicéntrico de cohortes prospectivas realizado en 36 hospitales españoles. Ambas cohortes se seguirán durante un periodo de 5 años con visitas completas cada 12 meses y controles telefónicos cada 6 meses para valorar las exacerbaciones y el estado vital del sujeto. El periodo de reclutamiento de casos se realizó entre el 15 de enero de 2010 y el 31 de marzo de 2012. En cada visita anual se recoge información sobre: (a) aspectos clínicos (situación socioeconómica, datos antropométricos, comorbilidades, tabaquismo, clínica respiratoria, exacerbaciones, calidad de vida, escala ansiedad-depresión, actividades de la vida diaria, tratamientos); (b) función respiratoria (espirometría, gasometría arterial, hiperinsuflación, difusión, presiones respiratorias); (c) índice BODE (variable principal del estudio); (d) función muscular periférica, y (e) analítica sanguínea (incluida IgE y factores de riesgo cardiovascular). Además, se creará una seroteca para la futura determinación de biomarcadores. Los datos de los pacientes son anonimizados en una base de datos con un acceso jerárquico para garantizar la seguridad en los accesos a la información. El estudio CHAIN aportará información sobre la progresión de la EPOC y establecerá una red de investigadores para futuros proyectos relacionados con la enfermedad.
    Archivos de Bronconeumología (English Edition). 12/2012; 48(12):453–459.
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    ABSTRACT: RATIONALE: Obstructive Sleep Apnea (OSA) has been associated with increased cancer mortality, but whether it is also associated with cancer incidence is unknown. OBJECTIVE: To investigate whether OSA is associated with increased cancer incidence in a large clinical cohort. METHODS: Multicenter, clinical cohort study including consecutive patients investigated for suspected OSA between 2003-2007 in 7 Spanish teaching hospitals. Apnea-hypopnea index (AHI) and percent night-time with oxygen saturation <90% (TSat90) were used as surrogates of OSA severity, both as continuous variables and categorized by tertiles. Cox proportional hazards regression analyses were used to calculate hazard ratios (HR) and 95%CI for cancer incidence after adjusting for confounding variables. MEASUREMENTS AND MAIN RESULTS: 4,910 patients were analyzed (median follow-up 4.5 years, IQR 3.4-5.2). Compared to the lower TSat90 category (<1.2%), the adjusted hazards (95%CI) of cancer incidence for increasing categories were 1.58 (1.07-2.34) for TSat90 1.2%-12% and 2.33 (1.57-3.46) for TSat90>12%. Continuous TSat90 was also associated with cancer incidence (adjusted HR 1.07 [1.02-1.13] per 10-unit increase in TSat90). In stratified analyses, TSat90 was associated with cancer incidence in patients <65 years (adjusted HR 1.13 [95%CI 1.06-1.21] per 10-unit increase in TSat90) and males (adjusted HR 1.11 [95%CI 1.04-1.17] per 10-unit increase in TSat90). AHI was not associated with cancer incidence in the adjusted analyses, except for patients <65 years (adjusted HR for AHI>43 vs. <18.7: 1.66, 95%CI 1.04-2.64). CONCLUSIONS: Increased overnight hypoxia as a surrogate of obstructive sleep apnea severity was associated with increased cancer incidence. This association seems to be limited to men and patients <65 years.
    American Journal of Respiratory and Critical Care Medicine 11/2012; · 11.04 Impact Factor
  • P. Dolado, A. Lazaro, J. M. Marin, B. Zalba
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    ABSTRACT: This paper studies the design and integration of PCM-Air heat exchangers as Thermal Energy Storage units for temperature maintenance in rooms. The methodology proposed is the use of design of experiments applied to numerical simulations on a theoretical model previously developed and experimentally validated. Although a theoretical model could be a useful tool for designers, such a design will not be sufficient if it is faced without a statistical approach. The proposed methodology is employed through the response surfaces in order to limit the number of simulation runs required to achieve an appropriate, or optimal, solution. When applied to the study case, this methodology shows an improvement of the proposed design compared to the one initially posed: the time to reach the threshold air temperature has been extended, the initial investment has been reduced, and the melting degree of the system has been improved; however, as a drawback, the TES unit volume has been increased. Furthermore, the proposed methodology has demonstrated to be a powerful tool to: reduce the number of numerical simulations runs and the invested time; improve the design; find an optimal point of operation; and find the factors settings that enable to fulfil with the requirements.
    Journal of Physics Conference Series 11/2012; 395(1):2132-.
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    ABSTRACT: ABSTRACT BACKGROUND: The new GOLD update includes airflow limitation, history of COPD exacerbations and symptoms to classify and grade COPD severity. We aimed to determine their distribution in eleven, well defined COPD cohorts, and their prognostic validity up to 10 years to predict time to death. METHODS: Spirometry in all eleven cohors was post-bronchodilator. Survival analysis and C-statistics were used to compare the two GOLD systems by varying time points. RESULTS: Of 3,633 patients, 1,064 (33.6%) were in new GOLD patient group A (low risk, less symptoms); 515 (16.3%) were B (low risk, more symptoms); 561 (17.7%) were C (high risk, less symptoms); and 1,023 (32.3%) were D (high risk, more symptoms). There was great heterogeneity of this distribution within the cohorts (Chi2 p value < 0.01). No differences were seen in the C statistics of old versus new GOLD grading to predict mortality at one year (0.635 vs. 0.639, p=0.53, at three years (0.637 vs. 0.645, p=0.21) or at 10 years (0.639 vs. 0.642, p=0.76). CONCLUSIONS: The new GOLD grading produces an uneven split of the COPD population, one third each in A and D patient groups, and its prognostic validity to predict time to death is no different than the old GOLD staging based in spirometry only.1Fundación Caubet-Cimera Illes Balears, Bunyola, Spain; 2Hospital Universitario Valme, Sevilla; 3Internal Medicine, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona; 4Hospital Nuestra Señora de la Candelaria, Tenerife; 5Hospital Galdakao-Usansolo, Galdakao, Bizkaia 6Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia; 7Clınica Universidad de Navarra, Pamplona; 8CAIBER, Oficina de Investigación Biosanitaria de Asturias, Oviedo; 9Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; 10Harvard University, Brigham and Women's Hospital, Pulmonary and Critical Care Medicine, Boston, MA, USA; 11Hospital Universitario Miguel Servet, Zaragoza, SpainAuthor for correspondence: Dr. Joan B Soriano Director, Program of Epidemiology & Clinical Research CIMERA. Recinte Hospital Joan March, Carretera Soller Km 12. 07110 - Bunyola, Illes Balears; Spain Email: jbsoriano@caubet-cimera.esFINANCIAL DISCLOSURE INFORMATION: No funding was required/available for COCOMICS.
    Chest 09/2012; · 7.13 Impact Factor
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    ABSTRACT: IntroductionAlthough asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD.MethodsA nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured «brainstorming» method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale.ResultsConsensus was reached about the existence of a differential clinical phenotype known as «Overlap Phenotype COPD-Asthma», whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV1 ≥ 15% and ≥ 400 ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV1 ≥ 12% and ≥ 200 ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients.Conclusions It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.
    Archivos de Bronconeumología. 09/2012; 48(9):331–337.

Publication Stats

4k Citations
376.16 Total Impact Points

Institutions

  • 2005–2014
    • Hospital Universitario Miguel Servet
      Caesaraugusta, Aragon, Spain
  • 2012
    • Hospital Universitario Virgen del Rocío
      Hispalis, Andalusia, Spain
  • 2003–2012
    • University of Zaragoza
      • • Department of Mechanical Engineering
      • • Área de Máquinas y Motores Térmicos
      Caesaraugusta, Aragon, Spain
  • 2011
    • Universidad de Navarra
      Iruña, Navarre, Spain
  • 2010
    • Hospital de Txagorritxu
      Vitoria, Basque Country, Spain
  • 2009
    • Clínica Universidad de Navarra
      Madrid, Madrid, Spain
  • 2008
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
    • Aragon Health Sciences Institute
      Caesaraugusta, Aragon, Spain
  • 2007
    • Universidad de La Laguna
      San Cristóbal de La Laguna, Canary Islands, Spain