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Pataka A.,Respiratory Failure Unit | Daskalopoulou E.,Sleep Laboratory | Kalamaras G.,Respiratory Failure Unit | Fekete Passa K.,Respiratory Failure Unit | Argyropoulou P.,Respiratory Failure Unit
Sleep Medicine | Year: 2014

Background: Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a major cause of morbidity and mortality. Different clinical models and questionnaires have been used to evaluate patients with the highest OSAHS probability. Objectives: To evaluate the clinical utility of five different questionnaires - STOP, STOPBang (SB), Berlin Questionnaire (BQ), Epworth Sleepiness Scale (ESS), and 4-Variable Screening Tool (4-V) - in a sleep clinic in order to identify patients at risk for OSAHS and to assess the best possible combination of these tools. Methods: 1853 (74.4% males) patients (mean age 52±14years; mean body mass index 32.8±7kg/m2) visiting a sleep clinic were studied retrospectively. Results: SB had the highest sensitivity (97.6%), the largest area under the receiver operating characteristics curve (AUC) (0.73; 95% CI, 0.7-0.76) and best OR (5.9; 95% CI, 3.6-9.5), but the lowest specificity (12.7%) for AHI ≥15. The 4-V ≥14 had the highest specificity (74.4%) followed by ESS (67%). BQ had good sensitivity (87%), worse specificity (33%) than 4-V and ESS but better than STOP (13%) and SB (12.7%). The combination of questionnaires did not improve their predictive value. Conclusions: SB had the highest sensitivity, OR, and AUC, but rather low specificity, and 4-V the highest specificity. The combination of different questionnaires did not improve their predictive value. © 2014 Elsevier B.V.. Source

Kendzerska T.,University of Toronto | Gershon A.S.,University of Toronto | Gershon A.S.,Institute for Clinical Evaluative science | Gershon A.S.,Sunnybrook Health science Center | And 7 more authors.
PLoS Medicine | Year: 2014

Background:Obstructive sleep apnea (OSA) has been reported to be a risk factor for cardiovascular (CV) disease. Although the apnea-hypopnea index (AHI) is the most commonly used measure of OSA, other less well studied OSA-related variables may be more pathophysiologically relevant and offer better prediction. The objective of this study was to evaluate the relationship between OSA-related variables and risk of CV events.Methods and Findings:A historical cohort study was conducted using clinical database and health administrative data. Adults referred for suspected OSA who underwent diagnostic polysomnography at the sleep laboratory at St Michael's Hospital (Toronto, Canada) between 1994 and 2010 were followed through provincial health administrative data (Ontario, Canada) until May 2011 to examine the occurrence of a composite outcome (myocardial infarction, stroke, congestive heart failure, revascularization procedures, or death from any cause). Cox regression models were used to investigate the association between baseline OSA-related variables and composite outcome controlling for traditional risk factors. The results were expressed as hazard ratios (HRs) and 95% CIs; for continuous variables, HRs compare the 75th and 25th percentiles. Over a median follow-up of 68 months, 1,172 (11.5%) of 10,149 participants experienced our composite outcome. In a fully adjusted model, other than AHI OSA-related variables were significant independent predictors: time spent with oxygen saturation <90% (9 minutes versus 0; HR = 1.50, 95% CI 1.25-1.79), sleep time (4.9 versus 6.4 hours; HR = 1.20, 95% CI 1.12-1.27), awakenings (35 versus 18; HR = 1.06, 95% CI 1.02-1.10), periodic leg movements (13 versus 0/hour; HR = 1.05, 95% CI 1.03-1.07), heart rate (70 versus 56 beats per minute [bpm]; HR = 1.28, 95% CI 1.19-1.37), and daytime sleepiness (HR = 1.13, 95% CI 1.01-1.28).The main study limitation was lack of information about continuous positive airway pressure (CPAP) adherence.Conclusion:OSA-related factors other than AHI were shown as important predictors of composite CV outcome and should be considered in future studies and clinical practice.Please see later in the article for the Editors' Summary. © 2014 Kendzerska et al. Source

Martinez-Garcia M.-A.,Polytechnic University of Valencia | Martinez-Garcia M.-A.,Research Center Biomedica En Red Of Enfermedades Respiratorias | Catalan-Serra P.,Pneumology Unit | Soler-Cataluna J.-J.,Pneumology Unit | And 6 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2012

Rationale: Obstructive sleep apnea (OSA) is a risk factor for cardiovascular death in middle-aged subjects, but it is not known whether it is also a risk factor in the elderly. Objectives: To investigate whether OSA is a risk factor for cardiovascular death and to assesswhether continuous positive airway pressure (CPAP) treatment is associated with a change in risk in the elderly. Methods: Prospective, observational study of a consecutive cohort of elderly patients (≥65 yr) studied for suspicion of OSA between 1998 and 2007. Patients with an apnea-hypopnea index (AHI) less than 15 were the control group. OSA was defined as mild to moderate (AHI, 15-29) or severe (AHI, ≥30). Patients with OSA were classified as CPAP-treated (adherence ≥ 4 h/d) or untreated (adherence < 4 h/dor not prescribed). Participants were monitored until December 2009. The end point was cardiovascular death. A multivariate Cox survival analysis was used to determine the independent impact of OSA and CPAP treatment on cardiovascular mortality. Measurements and Main Results: A total of 939 elderly were studied (median follow-up, 69 mo). Compared with the control group, the fully adjusted hazard ratios for cardiovascular mortality were 2.25 (confidence interval [CI], 1.41 to 3.61) for the untreated severe OSA group, 0.93 (CI, 0.46 to 1.89) for the CPAP-treated group, and 1.38 (CI, 0.73 to 2.64) for the untreated mild to moderate OSA group. Conclusions: Severe OSA not treated with CPAP is associated with cardiovascular death in the elderly, and adequate CPAP treatment may reduce this risk. Copyright © 2012 by the American Thoracic Society. Source

Billiard M.,Gui de Chauliac hospital | Podesta C.,Sleep Laboratory
Sleep Medicine | Year: 2013

Background: Recurrent hypersomnia (RH) following a traumatic brain injury (TBI) is a rare form of RH. According to the International Classification of Sleep Disorders, 2nd edition (ICSD-2), RH must be considered in the differential diagnosis as secondary to an organic insult of the central nervous system and not as the clinical subtype of RH, Kleine-Levin syndrome (KLS). The aim of our study was to investigate if cases of RH following TBI should be considered in the differential diagnosis of RH as indicated by the International Classification of Sleep Disorders, 2nd edition or as genuine, or indicated by ICSD-2, RH must cases of KLS. Methods: Twelve cases of RH developed after TBI were collected and analyzed for circumstance at onset, severity of TBI, delay between TBI and occurrence of first episode of RH, symptoms of RH, duration and cycle length of episodes of hypersomnia, physical signs, and brain morphological imaging at the time of hypersomnia episodes. Results: Factors such as the delay between TBI and the first episode of RH, the presence of other triggering factors and potential genetic factors, the degree of the severity of TBI, the presence or absence of any consistent brain imaging abnormality, provided the following results: (1) two of the cases could be considered as symptomatic of the underlying pathological brain process, (2) eight of the cases could be considered as simply triggered by TBI in patients at risk for KLS, and (3) two cases could be considered neither symptomatic nor triggered by TBI, due to the long delay between TBI and occurrence of symptoms. Conclusion: Cases of RH following TBI do not present under a single mechanism. Clinical assessment and laboratory tests are necessary to correctly classify them. © 2013. Source

Worsnop C.,Sleep Laboratory
Medicine Today | Year: 2015

Over the past few years, new drugs have been added to the bronchodilators and inhaled corticosteroids used for treating COPD. There is no strong evidence to say that one drug within a class is better than another and the decision about which drugs to use is mainly about patient preference, although multiple drugs from the same class should not be used in the same patient. © MedicineToday 2015. Source

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