Estimulación hipercápnica y respuesta ventilatoria en el síndrome de apnea obstructiva del sueño. Comparación de reinhalación y estado-estable
Hypercapnic stimulation and ventilatory response in obstructive sleep apnea syndrome. Comparison of rebreathing and stable techniques
J.G. Soto Campos*, S. Cano Gómez, J. Fernández Guerra, M.A. Sánchez Armengol, F. Capote Gil, J. Castillo Gómez
Servicio de Neumología. Hospital Universitario Virgen del Rocío. Sevilla
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Comparación de reinhalación y estado-estable" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "341" "paginaFinal" => "347" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.G. Soto Campos, S. Cano Gómez, J. Fernández Guerra, M.A. Sánchez Armengol, F. Capote Gil, J. Castillo Gómez" "autores" => array:6 [ 0 => array:3 [ "nombre" => "J.G." "apellidos" => "Soto Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Cano Gómez" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Fernández Guerra" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Sánchez Armengol" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Capote Gil" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Castillo Gómez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología. Hospital Universitario Virgen del Rocío. Sevilla" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Quevedo. 4. 1.°. 41100 Coria del Río." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Hypercapnic stimulation and ventilatory response in obstructive sleep apnea syndrome. Comparison of rebreathing and stable techniques" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1995-11-28" "fechaAceptado" => "1996-02-27" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec546166" "palabras" => array:4 [ 0 => "Respuesta ventilatoria hipercápnica" 1 => "Síndrome de apneas durante el sueño" 2 => "Control de respiración" 3 => "Método de reinspiraciones repetidas" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec546167" "palabras" => array:4 [ 0 => "Ventilatory responses to CO<span class="elsevierStyleInf">2</span>" 1 => "Sleep apnea syndrome" 2 => "Control of breathing" 3 => "Rebreathing" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue valorar la respuesta ventilatoria a la estimulación con carbónico en pacientes con síndrome de apneas obstructivas durante el sueño (SAOS) sin enfermedad pulmonar obstructiva crónica (EPOC), examinando las diferencias entre enfermos hiper y normocápnicos y comparando los resultados obtenidos con las dos técnicas usualmente empleadas en la estimulación hipercápnica (<span class="elsevierStyleItalic">rebreathing</span> y estado-estable). Para ello, hemos estudiado a 15 pacientes obesos, todos ellos con índice de apnea-hipopnea (IAH) superior a 10 en el registro polisomnográfico practicado durante una noche completa, a los que realizamos las siguientes pruebas funcionales respiratorias: espirometría, determinación de resistencias de vías aéreas y volúmenes estáticos pulmonares mediante pletismografía y gasometría arterial. Posteriormente analizamos la respuesta ventilatoria mediante el método de estado-estable, con concentraciones de CO<span class="elsevierStyleInf">2</span> progresivamente crecientes (1-9%) y la técnica de <span class="elsevierStyleItalic">rebreathing</span>. En el grupo total de enfermos obtuvimos resultados similares mediante ambos métodos, en el análisis de: ΔVE/ΔPCO<span class="elsevierStyleInf">2</span>, (0,64<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,35 frente a 0,67<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,48 1/min/mmHg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,59), ΔVt/ΔPCO<span class="elsevierStyleInf">2</span> (28,33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16,23 frente a 26,42<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16,94 ml/mmHg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,9), ΔVt/Ti/ΔPCO<span class="elsevierStyleInf">2</span> (28,82<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20,9 frente a 29,41<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>23,78 ml/s/mmHg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,89) y ΔP0, l/ΔPCO<span class="elsevierStyleInf">2</span> (0,11<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,07 frente a 0,117<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,05 cmH<span class="elsevierStyleInf">2</span>O/mmHg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,58). Comparamos los resultados obtenidos por ambas técnicas dividiendo a nuestra población en 2 grupos de 7 y 8 pacientes respectivamente, según el nivel de PaCO<span class="elsevierStyleInf">2</span> en vigilia fuese superior o inferior a 45 mmHg. Los enfermos hipercápnicos (grupo I) tenían una mayor edad (61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3,5 frente a 50<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 años; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,04) sin presentar diferencias en el índice de masa corporal con respecto a los pacientes normocápnicos (grupo II) (37,59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6,4 frente a 34,56<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,75 kg/m<span class="elsevierStyleSup">2</span>; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,33). Los resultados de ambas técnicas de estimulación hipercápnica fueron similares en los miembros de un mismo grupo existiendo una disminución estadísticamente significativa (p < 0,03), en los sujetos con hipercapnia diurna en ΔVE/ΔPCO<span class="elsevierStyleInf">2</span> ΔVt/ΔPCO<span class="elsevierStyleInf">2</span>, ΔVt/Ti/ΔPCO<span class="elsevierStyleInf">2</span> y ΔP0,1/ΔPCO<span class="elsevierStyleInf">2</span>. Concluimos que no existen diferencias en los resultados obtenidos en el estudio del control de la ventilación con las técnicas de <span class="elsevierStyleItalic">rebreathing</span> y estado-estable. Así mismo, la respuesta ventilatoria a la estimulación con CO<span class="elsevierStyleInf">2</span> en individuos con SAOS e hipoventilación diurna se encuentra disminuida en comparación con enfermos normocápnicos.</p></span>" ] "en" => array:1 [ "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The objetive of this study was to assess ventilatory response to stimulation with CO<span class="elsevierStyleInf">2</span> in patients suffering obstructive sleep apnea syndrome (OSAS) but without chronic obstructive pulmonary disease (COPD), by examining differences between hyper and normocapnic patients and comparing the results obtained with the usual techniques used to stimulate hypercapnia (rebreathing and stable-state). To this end, we studied 15 obese patients, all with an apnea-hypopnea index greater than 10 from a polysomnograph lasting a full night. The following lung function tests were performed: spirometry, air way resistance measures and static lung volumes by plethysmograph and arterial gasometry. We later analized ventilatory response by the stable-state method, with increasing CO<span class="elsevierStyleInf">2</span> concentrations (from 1 to 9%) and by the rebreathing method. Results from the two methods were similar for all patients: ΔVE/ΔPCO<span class="elsevierStyleInf">2</span> (0,64<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,35 vs 0,67<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,48 1/min/mmHg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,59), ΔVt/ΔPCO<span class="elsevierStyleInf">2</span>, (28,33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16,23 vs 26,42<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16,94 ml/mmHg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,9), ΔVt/Ti/ΔPCO<span class="elsevierStyleInf">2</span>, (28,82<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>20,9 vs 29,41<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>23,78 ml/s/mmHg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,89) y ΔP0, l/ΔPCO<span class="elsevierStyleInf">2</span> (0,11<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,07 vs 0,117<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,05 cmH<span class="elsevierStyleInf">2</span>O/mmHg; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>038). We compared the results obtained by the two techniques by dividing the sample into two groups of 7 and 8 patients, respectively, depending on whether PaCO<span class="elsevierStyleInf">2</span> level before stimulation was higher or lower than 45mmHg. The hypercapnic patients (group <span class="elsevierStyleSmallCaps">I</span>) were older (61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3,5 vs 50<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9 years; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,04) but were not different with respect to body mass freom the normocapnic patients (group <span class="elsevierStyleSmallCaps">II</span>) (37,59<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6,4 vs 34,56<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,75 kg/m<span class="elsevierStyleSup">2</span>; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,33). The results from the two techniques for stimulating hypercapnia were similar within each group, with a statistically significant decrease (p < 0,03) in patients with daytime hypercapnia in ΔVE/ΔPCO<span class="elsevierStyleInf">2</span> ΔVt/ΔPCO<span class="elsevierStyleInf">2</span>, ΔVt/Ti/ΔPCO<span class="elsevierStyleInf">2</span> and ΔP0,1/ΔPCO<span class="elsevierStyleInf">2</span>. We conclude that there are no differences in the results obtained with the rebreathing and stable state techniques. Likewise, ventilatory response to stimulation with CO<span class="elsevierStyleInf">2</span> in individuals with OSAS and daytime hypoventilation is less than of normocapnic patients.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| 2024 April | 29 | 18 | 47 |
| 2024 March | 33 | 26 | 59 |
| 2024 February | 30 | 28 | 58 |
| 2024 January | 0 | 1 | 1 |
| 2023 November | 0 | 2 | 2 |
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| 2023 January | 17 | 42 | 59 |
| 2022 December | 34 | 32 | 66 |
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| 2021 November | 22 | 36 | 58 |
| 2021 October | 30 | 32 | 62 |
| 2021 September | 23 | 35 | 58 |
| 2021 August | 17 | 38 | 55 |
| 2021 July | 24 | 31 | 55 |
| 2021 June | 36 | 23 | 59 |
| 2021 May | 27 | 29 | 56 |
| 2021 April | 23 | 77 | 100 |
| 2021 March | 34 | 17 | 51 |
| 2021 February | 33 | 17 | 50 |
| 2021 January | 30 | 10 | 40 |
| 2020 December | 29 | 15 | 44 |
| 2020 November | 20 | 14 | 34 |
| 2020 October | 24 | 14 | 38 |
| 2020 September | 27 | 17 | 44 |
| 2020 August | 35 | 17 | 52 |
| 2020 July | 26 | 12 | 38 |
| 2020 June | 27 | 15 | 42 |
| 2020 May | 32 | 13 | 45 |
| 2020 April | 29 | 10 | 39 |
| 2020 March | 35 | 15 | 50 |
| 2020 February | 23 | 20 | 43 |
| 2020 January | 40 | 23 | 63 |
| 2019 December | 46 | 26 | 72 |
| 2019 November | 27 | 9 | 36 |
| 2019 October | 29 | 14 | 43 |
| 2019 September | 32 | 14 | 46 |
| 2019 August | 12 | 9 | 21 |
| 2019 July | 24 | 20 | 44 |
| 2019 June | 19 | 7 | 26 |
| 2019 May | 36 | 20 | 56 |
| 2019 April | 41 | 34 | 75 |
| 2019 March | 25 | 18 | 43 |
| 2019 February | 14 | 10 | 24 |
| 2019 January | 14 | 6 | 20 |
| 2018 December | 13 | 12 | 25 |
| 2018 November | 26 | 12 | 38 |
| 2018 October | 39 | 12 | 51 |
| 2018 September | 17 | 10 | 27 |
| 2018 May | 6 | 1 | 7 |
| 2018 April | 4 | 5 | 9 |
| 2018 March | 3 | 6 | 9 |
| 2018 February | 8 | 11 | 19 |
| 2018 January | 7 | 8 | 15 |
| 2017 December | 6 | 12 | 18 |
| 2017 November | 7 | 15 | 22 |
| 2017 October | 7 | 9 | 16 |
| 2017 September | 3 | 10 | 13 |
| 2017 August | 10 | 11 | 21 |
| 2017 July | 4 | 8 | 12 |
| 2017 June | 11 | 20 | 31 |
| 2017 May | 14 | 10 | 24 |
| 2017 April | 7 | 7 | 14 |
| 2017 March | 4 | 15 | 19 |
| 2017 February | 4 | 10 | 14 |
| 2017 January | 5 | 4 | 9 |
| 2016 December | 10 | 13 | 23 |
| 2016 November | 22 | 16 | 38 |
| 2016 October | 24 | 24 | 48 |
| 2016 September | 26 | 21 | 47 |
| 2016 August | 14 | 4 | 18 |
| 2016 July | 19 | 11 | 30 |
| 2016 June | 21 | 12 | 33 |
| 2016 May | 12 | 5 | 17 |
| 2016 April | 13 | 0 | 13 |
| 2016 March | 9 | 1 | 10 |
| 2016 February | 6 | 1 | 7 |
| 2016 January | 25 | 7 | 32 |
| 2015 December | 27 | 15 | 42 |
| 2015 November | 31 | 4 | 35 |
| 2015 October | 6 | 1 | 7 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 June | 1 | 0 | 1 |
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