A new tool to screen patients with severe obstructive sleep apnea in the primary care setting : a prospective multicenter study

Altres ajuts: Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Societat Catalana de Pneumologia (SOCAP).The coordination between different levels of care is essential for the management of obstructive sleep apnea (OSA). The objective of this multicenter project was to develop a screening model for OSA in the primary care setting. Anthropometric data, clinical history, and symptoms of OSA were recorded in randomly selected primary care patients, who also underwent a home sleep apnea test (HSAT). Respiratory polygraphy or polysomnography were performed at the sleep unit to establish definite indication for continuous positive airway pressure (CPAP). By means of cross-validation, a logistic regression model (CPAP yes/no) was designed, and with the clinical variables included in the model, a scoring system was established using the β coefficients (PASHOS Test). In a second stage, results of HSAT were added, and the final accuracy of the model was assessed. 194 patients completed the study. The clinical test included the body mass index, neck circumference and observed apneas during sleep (AUC 0.824, 95% CI 0.763-0.886, P < 0.001). In a second stage, the oxygen desaturation index (ODI) of 3% (ODI3% ≥ 15%) from the HSAT was added (AUC 0.911, 95% CI 0.863-0.960, P < 0.001), with a sensitivity of 85.5% (95% CI 74.7-92.1) and specificity of 67.8% (95% CI 55.1-78.3). The use of this model would prevent referral to the sleep unit for 55.1% of the patients. The two-stage PASHOS model is a useful and practical screening tool for OSA in primary care for detecting candidates for CPAP treatment. Clinical Trial Registration Registry: ClinicalTrials.gov; Name: PASHOS Project: Advanced Platform for Sleep Apnea Syndrome Assessment; URL: ; Identifier: NCT02591979. Date of registration: October 30, 2015. The online version contains supplementary material available at 10.1186/s12890-022-01827-0

Efecte del tractament de la síndrome d'apnea-hipoapnea obstructiva del son amb pressió positiva contínua a la via aèria superior sobre les alteracions del ritme cardíac

La Síndrome d’apnea-hipoapnea obstructiva del son (SAHS) produeix una deficient resposta de la freqüència cardíaca (FC) als estímuls vagal i simpàtic (variabilitat de la FC -VFC- alterada). Els pacients amb flutter auricular (FlA) tenen un alt risc de presentar fibril·lació auricular (FA). Està per definir l’impacte del tractament amb pressió positiva contínua (CPAP) sobre la via aèria superior en la incidència de FA després de l’ablació del FlA i sobre la VFC. En l’Estudi 1 vam observar que els pacients amb FlA tenen una alta prevalença de SAHS (82%). El tractament amb CPAP dels pacients amb SAHS greu sense FA prèvia es va acompanyar d’una reducció en la incidència de FA (p = 0.025). En l’Estudi 2 vam observar que la SAHS altera els paràmetres diürns i nocturns de VFC. El tractament amb CPAP es va associar a una milloria parcial i només durant la vigília de la VFC (p < 0.05).Obstructive sleep apnea (OSA) produces a deficient heart rate response to the vagal and sympathetic stimuli (altered heart rate variability, HRV) and increases the incidence of atrial arrhythmias. Patients with typical atrial flutter (AFl) are at high risk of developing atrial fibrillation (AF), and the incidental finding of OSA may further increase the risk of AF after AFl ablation. The role of continuous positive airway pressure (CPAP) in improving HRV and reducing the incidence of AF after AFl ablation remains undetermined. In our Study 1 we observed that OSA is a very prevalent underlying condition among AFl patients (82% have OSA of any degree) and treatment with CPAP reduced the incidence of newly diagnosed AF (p = 0.025). In our Study 2 we observed that HRV is altered in the setting of OSA, and CPAP only partially ameliorates such autonomic nervous system disorder and exclusively during daytime (p < 0.05)