Apnea obstructiva del sueño posicional. Implicaciones clínicas.

Positional obstructive sleep apnea (POSA) include patients with a higher rate of respiratory events in the decubitus-supine position. There is no consensus on the diagnosis of POSA, and several criteria coexist. The main hypothesis is based on the fact that the different criteria defining POSA could affect the prevalence, clinical characteristics and management of these patients. Positional patients could present greater cardiac autonomic imbalance. The main objective is to characterize POSA patients according to the APOC classification and to analyze their differences with respect to NON-POSA patients. The specific objectives are: to determine the prevalence of POSA, examine differences among APOC categories, polysomnographic and pulse oximetric characteristics, analyze repercussions on quality of sleep, life and adherence to treatment, and investigate the influence on cardiac autonomic modulation. A prospective study was conducted with 409 patients referred to sleep clinic of the Universitary Hospital Río Hortega (July 2016 - April 2018). Complete home unmonitored nocturnal polysomnography and simultaneous recording of pulse oximetry were performed. Somnolence, sleep quality and quality of life were studied using the Epworth, Pittsburg and EuroQoL-5D questionnaires. CPAP treatment adherence variables were obtained by telemonitoring. The influence of the main definitions on the prevalence of POSA was investigated. Positional patients were analyzed according to the new APOC criteria: POSA vs. non-POSA groups. A multiclass study was performed according to APOC categories (I, II and III). Cardiac autonomic modulation was assessed through pulse rate variability (PRV) obtained by portable pulse oximetry. Conventional cardiac indexes were calculated in time and frequency, as well as multiscale entropy. Statistical analysis was performed with SPSS Statistics 24. A total of 320 patients were analyzed (21.8% were excluded due to dropout or failure to register). Of them, 233 met APOC criteria for POSA evaluation. There was great variability in the prevalence of POSA according to the reference criterion used (19.1% to 55.4%). No significant differences were found in terms of age or sex between the POSA and non-POSA groups. Positional patients displayed lower body mass index, with the APOC I group being younger. As the APOC category increased, a gradual increase in AHI, apnea index and hypopnea index was observed. The Non-POSA group displayed more pathological oximetry values than APOC I patients. There were no differences in the Epworth scale or in the Pittsburg sleep quality index. There were no significant differences in adherence to CPAP. With respect to cardiac autonomic modulation, no significant differences were found using conventional indexes. In the nonlinear context, POSA patients displayed higher entropy (greater disorder or imbalance) at low time scales (tao <6). The largest differences were observed at the smallest time scales, with significant differences between Non-POSA patients and all APOC categories (tao = 2). The results suggest that the POSA defining criterion notably affects the prevalence of the positional phenotype of OSA. As the APOC category increases, a deterioration of clinical parameters, polysomnographic indexes and increased impairment of quality of life are observed. The PRV signal displays higher autonomic imbalance in POSA patients. Multiscale entropy is useful, unlike traditional cardiac indexes, to characterize changes in nocturnal cardiac dynamics linked to positional apneas. We conclude that POSA patients could display greater cardiac involvement, so POSA may not represent a milder disease state.La apnea obstructiva del sueño posicional (POSA) engloba a los pacientes con mayor tasa de eventos respiratorios en posición decúbito-supino. No existe consenso para diagnosticar POSA, coexistiendo varios criterios. La hipótesis principal se fundamenta en que los diversos criterios definitorios de POSA podrían afectar a la prevalencia, las características clínicas y el manejo de estos pacientes. Los pacientes posicionales podrían presentar mayor desbalance autonómico cardiaco. El objetivo principal consiste en caracterizar a los pacientes POSA según la clasificación APOC y analizar sus diferencias con respecto a pacientes NO-POSA. Como objetivos específicos se proponen: determinar prevalencia de POSA, examinar diferencias entre categorías APOC, características polisomnográficas y pulsioximétricas, analizar repercusiones sobre calidad de sueño, vida y adherencia al tratamiento, estudiar influencia sobre la modulación autonómica cardiaca. Estudio prospectivo con 409 pacientes remitidos a consulta de sueño del Hospital Universitario Río Hortega (julio 2016 - abril 2018). Se realizó polisomnografía nocturna completa no vigilada domiciliaria y registro simultáneo de pulsioximetria. Se estudió la somnolencia, calidad de sueño y de vida mediante los cuestionarios Epworth, Pittsburg y EuroQoL-5D. Las variables de adherencia al tratamiento CPAP se obtuvieron por telemonitorización. Se investigó la influencia de las principales definiciones sobre la prevalencia de POSA. Se analizaron los pacientes posicionales según el nuevo criterio APOC: grupos POSA vs. No-POSA. Se realizó un estudio multiclase en función de las categorías APOC (I, II y III). La modulación autonómica cardiaca se evaluó a través de la variabilidad de la frecuencia de pulso (PRV) obtenida mediante pulsioximetría portátil. Se calcularon los índices cardíacos convencionales en tiempo y frecuencia, así como la entropía multiescala. El análisis estadístico se realizó con SPSS Statistics 24. Se analizaron un total de 320 pacientes (21.8% fueron excluidos por abandono o fallo de registro). De ellos, 233 cumplían criterios APOC de evaluación de POSA. Se evidenció una gran variabilidad en la prevalencia de POSA según el criterio de referencia utilizado (19.1% a 55.4%). No se encontraron diferencias significativas en términos de edad o sexo entre los grupos con y sin POSA. Los pacientes posicionales mostraron menor índice de masa corporal, siendo el grupo APOC I más joven. Al aumentar de categoría APOC se observó un crecimiento gradual del IAH, índice de apnea e índice de hipopnea. El grupo No-POSA mostró valores oximétricos más patológicos que los pacientes APOC I. No hubo diferencias en la escala Epworth ni en el índice de calidad de sueño de Pittsburg. No hubo diferencias significativas en cumplimiento con CPAP. Con respecto a la modulación autonómica cardiaca, no se encontraron diferencias significativas empleando los índices cardíacos convencionales. En el contexto no lineal, los pacientes con POSA mostraron una entropía mayor (mayor desorden o disbalance) en las escalas de tiempo bajas (tao <6). Las mayores diferencias se observaron en las escalas temporales más pequeñas, con diferencias significativas entre los pacientes No-POSA y todas las categorías APOC (tao = 2). Los resultados sugieren que el criterio definitorio POSA influye notablemente en la prevalencia del fenotipo posicional de AOS. Conforme aumenta la categoría APOC, se observa un empeoramiento de los parámetros clínicos, índices polisomnográficos y mayor afectación de la calidad de vida. La señal PRV muestra mayor desbalance autonómico en los pacientes POSA. La entropía multiescala es útil, a diferencia de los índices cardíacos tradicionales, para caracterizar cambios en la dinámica cardiaca nocturna vinculados a las apneas posicionales. Se concluye que los pacientes POSA podrían mostrar mayor afectación cardiaca, por lo que la POSA podría no representar un estado de enfermedad más leve.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la Salu

Vasoespastic angina, plaque erosion, ischemia and cardiac arrest: four of a kind or straight?

A 56-year-old woman, current smoker with a history of arterial hypertension and dyslipidemia was previously studied due to recurrent syncope with chest pain associated in recent months. Normal cardiac morphology and function was assessed by echocardiography and a coronary computed tomography angiography showed a noncalcified plaque with a 40% stenosis in the left anterior descending coronary artery (LAD). Single antiplatelet therapy and a statin were started..

Troballes i trobades

[ca] Troballes i trobades és un recull d’obres d’artistes novells de l’àmbit d’Escultura del Treball Final de Grau en Belles Arts en el curs 2022-2023 i d’artistes en formació en el curs 2023-2024. Les peces que componen l’exposició esdevenen evidències –troballes– de processos de recerca i producció artística –trobades–, però també compendis d’objectes, taxonomies, cartografies i històries. Composicions escultòriques que dialoguen entre sí i amb una peça de cocreació artística itinerant –feta d’allò que ens deixen. Entre les sales domèstiques i domesticades del Can Castells Centre d’Art trobarem obres que, des d’una dimensió creativa –amb morfologies i estètiques constructives– ens parlen d’emocions i memòria, de natura i preservació. Tan sols un tornar a l’ésser des de la troballa i un potenciar la trobada –recuperar, arxivar, compartir i reflexionar des de la quotidianitat– han de permetre que els públics es facin seu el que passa en els territoris contemporanis de l’art. Us convidem a que participeu en les peces i els processos: a que trobeu, però també a que aporteu. Feu-vos vostra l’exposició

Multi-Class AdaBoost to Detect Sleep Apnea-Hypopnea Syndrome Severity from Oximetry Recordings Obtained at Home

Producción CientíficaThis paper aims at evaluating a novel multi-class methodology to establish Sleep Apnea-Hypopnea Syndrome (SAHS) severity by the use of single-channel at-home oximetry recordings. The study involved 320 participants derived to a specialized sleep unit due to SAHS suspicion. These were assigned to one out of the four SAHS severity degrees according to the apnea-hypopnea index (AHI): no-SAHS (AHI<5 events/hour), mild-SAHS (5≤AHI<15 e/h), moderate-SAHS (15≤AHI<30 e/h), and severe-SAHS (AHI≥30 e/h). A set of statistical, spectral, and non-linear features were extracted from blood oxygen saturation (SpO2) signals to characterize SAHS. Then, an optimum set among these features were automatically selected based on relevancy and redundancy analyses. Finally, a multi-class AdaBoost model, built with the optimum set of features, was obtained from a training set (60%) and evaluated in an independent test set (40%). Our AdaBoost model reached 0.386 Cohen’s kappa in the four-class classification task. Additionally, it reached accuracies of 89.8%, 85.8%, and 74.8% when evaluating the AHI thresholds 5 e/h, 15 e/h, and 30 e/h, respectively, outperforming the classic oxygen desaturation index. Our results suggest that SpO2 obtained at home, along with multi-class AdaBoost, are useful to detect SAHS severity.Junta de Castilla y León (project VA059U13)Pneumology and Thoracic Surgery Spanish Society (265/2012

Automated Analysis of Unattended Portable Oximetry by means of Bayesian Neural Networks to Assist in the Diagnosis of Sleep Apnea

Producción CientíficaSleep apnea-hypopnea syndrome (SAHS) is a chronic sleep-related breathing disorder, which is currently considered a major health problem. In-lab nocturnal polysomnography (NPSG) is the gold standard diagnostic technique though it is complex and relatively unavailable. On the other hand, the analysis of blood oxygen saturation (SpO2) from nocturnal pulse oximetry (NPO) is a simple, noninvasive, highly available and effective alternative. This study focused on the design and assessment of a neural network (NN) aimed at detecting SAHS using information from at-home unsupervised portable SpO2 recordings. A Bayesian multilayer perceptron NN (MLP-NN) was proposed, fed with complementary oximetric features properly selected. A dataset composed of 320 unattended SpO2 recordings was analyzed (60% for training and 40% for validation). The proposed Bayesian MLP-NN achieved 94.2% sensitivity, 69.6% specificity, and 89.8% accuracy in the test set. Our results suggest that automated analysis of at-home portable NPO recordings by means of Bayesian MLP-NN could be an effective and highly available technique in the context of SAHS diagnosis.Junta de Castilla y León (project VA059U13)Pneumology and Thoracic Surgery Spanish Society (265/2012

Assessment of nocturnal autonomic cardiac imbalance in positional obstructive sleep apnea. A multiscale nonlinear approach

Producción CientíficaPositional obstructive sleep apnea (POSA) is a major phenotype of sleep apnea. Supine-predominant positional patients are frequently characterized by milder symptoms and less comorbidity due to a lower age, body mass index, and overall apnea-hypopnea index. However, the bradycardia-tachycardia pattern during apneic events is known to be more severe in the supine position, which could affect the cardiac regulation of positional patients. This study aims at characterizing nocturnal heart rate modulation in the presence of POSA in order to assess potential differences between positional and non-positional patients. Patients showing clinical symptoms of suffering from a sleep-related breathing disorder performed unsupervised portable polysomnography (PSG) and simultaneous nocturnal pulse oximetry (NPO) at home. Positional patients were identified according to the Amsterdam POSA classification (APOC) criteria. Pulse rate variability (PRV) recordings from the NPO readings were used to assess overnight cardiac modulation. Conventional cardiac indexes in the time and frequency domains were computed. Additionally, multiscale entropy (MSE) was used to investigate the nonlinear dynamics of the PRV recordings in POSA and non-POSA patients. A total of 129 patients (median age 56.0, interquartile range (IQR) 44.8–63.0 years, median body mass index (BMI) 27.7, IQR 26.0–31.3 kg/m2) were classified as POSA (37 APOC I, 77 APOC II, and 15 APOC III), while 104 subjects (median age 57.5, IQR 49.0–67.0 years, median BMI 29.8, IQR 26.6–34.7 kg/m2) comprised the non-POSA group. Overnight PRV recordings from positional patients showed significantly higher disorderliness than non-positional subjects in the smallest biological scales of the MSE profile (τ = 1: 0.25, IQR 0.20–0.31 vs. 0.22, IQR 0.18–0.27, p < 0.01) (τ = 2: 0.41, IQR 0.34–0.48 vs. 0.37, IQR 0.29–0.42, p < 0.01). According to our findings, nocturnal heart rate regulation is severely affected in POSA patients, suggesting increased cardiac imbalance due to predominant positional apneas.Ministerio de Ciencia, Innovación y Universidades - Fondo Europeo de Desarrollo Regional (Proyects DPI2017-84280-R and RTC-2017-6516-1)Sociedad Española de Neumología y Cirugía Torácica (Proyects 649/2018 and 66/2016)Gerencia Regional de Salud de Castilla y León (Proyecto GRS 1950/A/19)Ministerio de Educación, Cultura y Deporte (Proyecto FPU16/02938)Gerencia Regional de Salud de Castilla y León - (Projecto INT/M/15/20

Base de datos de abejas ibéricas

Las abejas son un grupo extremadamente diverso con más de 1000 especies descritas en la península ibérica. Además, son excelentes polinizadores y aportan numerosos servicios ecosistémicos fundamentales para la mayoría de ecosistemas terrestres. Debido a los diversos cambios ambientales inducidos por el ser humano, existen evidencias del declive de algunas de sus poblaciones para ciertas especies. Sin embargo, conocemos muy poco del estado de conservación de la mayoría de especies y de muchas de ellas ignoramos cuál es su distribución en la península ibérica. En este trabajo presentamos un esfuerzo colaborativo para crear una base de datos de ocurrencias de abejas que abarca la península ibérica e islas Baleares que permitirá resolver cuestiones como la distribución de las diferentes especies, preferencia de hábitat, fenología o tendencias históricas. En su versión actual, esta base de datos contiene un total de 87 684 registros de 923 especies recolectados entre 1830 y 2022, de los cuales un 87% presentan información georreferenciada. Para cada registro se incluye información relativa a la localidad de muestreo (89%), identificador y colector de la especie (64%), fecha de captura (54%) y planta donde se recolectó (20%). Creemos que esta base de datos es el punto de partida para conocer y conservar mejor la biodiversidad de abejas en la península ibérica e Islas Baleares. Se puede acceder a estos datos a través del siguiente enlace permanente: https://doi.org/10.5281/zenodo.6354502ABSTRACT: Bees are a diverse group with more than 1000 species known from the Iberian Peninsula. They have increasingly received special attention due to their important role as pollinators and providers of ecosystem services. In addition, various rapid human-induced environmental changes are leading to the decline of some of its populations. However, we know very little about the conservation status of most species and for many species, we hardly know their true distributions across the Iberian Peninsula. Here, we present a collaborative effort to collate and curate a database of Iberian bee occurrences to answer questions about their distribution, habitat preference, phenology, or historical trends. In total we have accumulated 87 684 records from the Iberian Peninsula and the Balearic Islands of 923 different species with 87% of georeferenced records collected between 1830 and 2022. In addition, each record has associated information such as the sampling location (89%), collector and person who identified the species (64%), date of the capture (54%) and plant species where the bees were captured (20%). We believe that this database is the starting point to better understand and conserve bee biodiversity in the Iberian Peninsula. It can be accessed at: https://doi.org/10.5281/zenodo.6354502Esta base de datos se ha realizado con la ayuda de los proyectos EUCLIPO (Fundação para a Ciência e a Tecnologia, LISBOA-01-0145-FEDER-028360/EUCLIPO) y SAFEGUARD (ref. 101003476 H2020 -SFS-2019-2).info:eu-repo/semantics/publishedVersio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries