Obstructive sleep apnea — diagnosis and treatment options

Obturacyjny bezdech senny (OSA) jest schorzeniem polegającym na powtarzających się epizodach bezdechów i spłyceń oddechu spowodowanych całkowitą bądź częściową blokadą przepływu powietrza. Głównymi objawami OSA są: nadmierna senność w ciągu dnia, nagłe wybudzenia z uczuciem zatrzymania oddechu lub duszenia się, suchość w jamie ustnej po przebudzeniu, poranne bóle głowy, trudności w koncentracji, potliwość nocna i inne. Częstość występowania OSA jest wysoka i prawdopodobnie, z powodu zwiększającej się częstości otyłości, będzie większa w przyszłości. W wielu badaniach wykazano korelacje między OSA a innymi schorzeniami, takimi jak: nadciśnienie tętnicze, przewlekła niewydolność krążenia, choroba niedokrwienna serca, arytmie, udar mózgu. Istnieje również wiele publikacji wskazujących na korzystny wpływ terapii z użyciem stałego dodatniego ciśnienia w drogach oddechowych (CPAP) na schorzenia współistniejące. „Złotym standardem” w diagnostyce OSA jest tak zwana stacjonarna polisomnografia (PSG), ale urządzenia przenośne typu 3 (z min. 4 kanałami) również są akceptowalne w diagnostyce pacjentów wyjściowo obciążonych umiarkowanym lub wysokim ryzykiem OSA. Diagnozę stawia się na podstawie wyników PSG i objawów. Na podstawie wyniku PSG można podzielić OSA na 3 grupy — łagodne, umiarkowane i ciężkie. Według aktualnych wytycznych i publikacji CPAP jest leczeniem pierwszego wyboru w umiarkowanej i ciężkiej postaci OSA. Strategia lecznicza w przypadku bezdechu łagodnego zależy od zdrowia pacjenta, schorzeń współistniejących i indywidualnych decyzji chorego. Innymi opcjami leczenia są aparaty wewnątrzustne, leczenie pozycyjne i chirurgiczne, ale żadna z tych metod nie dorównuje korzyściom wynikającym z terapii CPAP.Obstructive sleep apnea (OSA) is a disease characterized by recurrent episodes of apneas and hypopneas, caused by total or partial airway obstruction. Main symptoms of OSA are: excessive daytime sleepiness, snoring, waking up suddenly feeling like gasping or choking, dry mouth or sore throat after waking up, morning headaches, trouble concentrating, night sweats and others. Prevalence of OSA is high and probably — due to increasing prevalence of obesity — will be higher in the future. Many studies show correlation between OSA and other diseases such as hypertension, chronic heart failure, coronary artery disease, arrhythmias and stroke. There are also many publications showing positive impact of CPAP treatment on managing comorbidities. Gold standard in diagnosis of OSA is in-laboratory polysomnography (PSG), although type 3 portable monitors (with at least 4 channels) are also acceptable to diagnose patients with pre- -test moderate to high risk of OSA. Diagnosis is made based on PSG results and symptoms. Based on PSG results, we can divide OSA into 3 groups: mild, moderate and severe. Based on current guidelines and publications, continuous positive airway pressure (CPAP) is a first choice treatment in moderate and severe OSA. Treatment strategies in mild OSA depend on patient health, comorbidities and individual patient decisions. Other treatment options are oral appliances, positional treatment and surgery but none of them equals CPAP’s benefits

Sudden cardiac death athletes: a systematic review

Previous events evidence that sudden cardiac death (SCD) in athletes is still a reality and it keeps challenging cardiologists. Considering the importance of SCD in athletes and the requisite for an update of this matter, we endeavored to describe SCD in athletes. The Medline (via PubMed) and SciELO databases were searched using the subject keywords "sudden death, athletes and mortality". The incidence of SCD is expected at one case for each 200,000 young athletes per year. Overall it is resulted of complex dealings of factors such as arrhythmogenic substrate, regulator and triggers factors. In great part of deaths caused by heart disease in athletes younger than 35 years old investigations evidence cardiac congenital abnormalities. Athletes above 35 years old possibly die due to impairments of coronary heart disease, frequently caused by atherosclerosis. Myocardial ischemia and myocardial infarction are responsible for the most cases of SCD above this age (80%). Pre-participatory athletes' evaluation helps to recognize situations that may put the athlete's life in risk including cardiovascular diseases. In summary, cardiologic examinations of athletes' pre-competition routine is an important way to minimize the risk of SCD

Gender differences in dual-chamber pacemaker implantation indications and long-term outcomes

Objective: Dual-chamber (DDD) pacing is the most commonly used mode of heart stimulation. The data on gender-related differences in the long-term follow-up of DDD pacing mode are still limited. We performed a retrospective single-centre study to determine the effect of gender on the implantation indications and the incidence of adverse events resulting in DDD mode loss. Methods and results: A group of 1,049 consecutive patients with DDD pacemaker implanted between 1984 and 2002 were followed up until 2014. The study group consisted of 995 patients who performed at least one follow-up visit. Follow-up period was 124.2 ± 68.3 months, mean age was 63.5 ± 12.4 years, 56% were male. Adverse events were defined as loss of primary DDD stimulation – lead malfunction, progression to permanent AF, and infective complications. Women were older than men (64.7 vs 62.6 years) at the time of implantation and they remained, on average, 1.5 year longer in follow-up compared with men. Female patients had significantly more SSS, history of paroxysmal AF, and a similar percentage of AVB compared with male patients. The incidence of lead malfunction, device-related infections, and progression to permanent AF did not show significant differences. However, in the group without prior paroxysmal AF, women developed permanent AF more frequently. Conclusions: This patients cohort showed that there is an association between gender and indications to DDD pacing therapy. The rate of adverse events was similar in both genders. Women had a significantly longer duration of follow-up, despite markedly higher age at implantation