Disminución del requerimiento del nivel de CPAP tras un tratamiento prolongado en pacientes con síndrome de apneas obstructivas durante el sueño
Decrease in CPAP level required after long-term treatment in patients with obstructive sleep apnea syndrome
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"apellidos" => "Parra" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Neumología y Alergia Respiratoria. Hospital Clínic i Provincial de Barcelona. Montreal. Canadá" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "1" "correspondencia" => "Correspondencia: Servicio de Neumología. Hospital Clínic i Provincial. Villarrocl, 170. 08036 Barcelona. Subvencionado por beca SEPAR Carburos-92." ] ] ] 1 => array:3 [ "autoresLista" => "J. Kimoff, M. Cosío" "autores" => array:2 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "Kimoff" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Cosío" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Royal Victoria University. McGill University. Montreal. Canadá" "etiqueta" => "*" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Decrease in CPAP level required after long-term treatment in patients with obstructive sleep apnea syndrome" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "1993-09-06" "fechaAceptado" => "1994-02-08" "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La aplicación durante el sueño de una presión positiva continua en la vía aérea superior (CPAP) es el tratamiento de elección del síndrome de apneas obstructivas del sueño (SAOS). Su mecanismo de acción consiste fundamentalmente en el mantenimiento de la permeabilidad de la vía aérea superior por un efecto de “entablillado neumático” sobre las paredes faríngeas. Sin embargo, se ha sugerido que el tratamiento prolongado con CPAP nasal puede además mejorar los mecanismos fisiopatológicos responsables del SAOS a través de diversas vías como la reducción del edema de la mucosa faríngea, la modificación de la dinámica muscular de la vía aérea superior o incluso una reducción en la intensidad de los fenómenos responsables del despertar transitorio y el final de las apneas. El objetivo del presente estudio es determinar si el tratamiento prolongado con CPAP nasal se asocia a una disminución de la presión de CPAP requerida para la desaparición de las apneas en pacientes con SAOS. Se analizaron 22 pacientes diagnosticados de SAOS mediante polisomnografía convencional (que incluía el estudio durante el sueño de variables neurológicas -electroencefalograma, movimientos oculares, electromiograma submentoniano-, respiratorias -flujo aéreo nasal, movimientos toracoabdominales, saturación de la oxihemoglobinay otras -electrocardiograma, movilidad de las piernas-) y tratados exclusivamente con CPAP nasal. Los 22 pacientes analizados (18 varones y 4 mujeres), de edad media 52,3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 años, presentaban un índice de apnea/hipopnea medio de 65,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>24 por hora. Dichos pacientes fueron sometidos a una medición de los niveles de CPAP necesarios para la desaparición de las apneas, las desaturaciones de la oxihemoglobina y los ronquidos, en el momento del diagnóstico y tras un período prolongado de tratamiento (8,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,6 meses), y a todos ellos se les controló el peso en ambas mediciones. De los 22 pacientes analizados, 18 (17 varones, una mujer, edad media 53,1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11,4 años e índice de apnea/ hipopnea de 64,8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>23,4 por hora) no variaron de peso corporal a lo largo del tratamiento. En este grupo de pacientes, la presión de CPAP requerida inicialmente para la desaparición de las apneas fue de 10,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,3<span class="elsevierStyleHsp" style=""></span>cm de H<span class="elsevierStyleInf">2</span>0 y de 8,8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,1<span class="elsevierStyleHsp" style=""></span>cm de H<span class="elsevierStyleInf">2</span>O tras el período de tratamiento con CPAP (p < 0,05). Los requerimientos de CPAP fueron mayores en los dos sujetos que aumentaron de peso corporales y menores o iguales en los dos sujetos que habían perdido peso. La variación en la presión de CPAP no se correlacionó con el índice de apnea/hipopnea, el peso corporal, la presión inicial de CPAP ni la duración del tratamiento. En consecuencia, este estudio demuestra que la presión mínima de CPAP requerida para la desaparición de las apneas disminuye tras un tratamiento prolongado. Por tanto, es recomendable impulsar a los pacientes al cumplimiento del tratamiento y repetir la medición de los niveles de CPAP después de varios meses de tratamiento para asegurar el empleo de la mínima presión de CPAP requerida para la abolición de las apneas obstructivas durante el sueño.</p></span>" ] "en" => array:1 [ "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Application of continuous positive upper airway pressure (CPAP) is the treatment of choice in obstructive sleep apnea syndrome (OSAS). CPAP keeps the upper airway open by providing a “pneumatic solint” on the pharyngeal walls. However, it has been suggested that prolonged nasal CPAP treatment may also improve the physiopathological mechanisms responsible for OSAS by a variety of mechanisms such as the reduction of edema of the pharyngeal mucosa, modification of upper airway muscle dynamics; there may even be a reduction in the intensity of phenomena responsible for brief awakening and ending of apneic episodes. The objective of this study was to determine whether prolonged nasal CPAP is associated to a reduction of CPAP pressure required for eliminating apnea in patients with OSAS. We studied 22 patients (4 women) with OSAS diagnosed by conventional polysomnography, including study of neurological variables during sleep (electroencephalogram, ocular movement, submentonal electromyogram), respiratory variables (nasal air flow, thoracicabdominal movement, 02 saturation in the blood), and others (electrocardiogram, leg movement). Treatment was exclusively with nasal CPAP. AU 22 patients were middle-aged (52.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10 years), presented a mean apnea/hypoapnea index of 65.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>24 per hour. CPAP levels needed to eliminate episodes of apnea, blood O2 desaturation and snoring at the time of diagnosis and after long-term treatment (8.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.6 months) were applied. Weight was recorder at both measurement times. Eighteen of the 22 patients (1 woman, mean age 53.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.4 years and apnea/hypopnea Índex 64.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>23.4 per hour) experienced no weight change during treatment. In this group the CPAP level required initially for elimination of apnei< episodes was 10.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.3<span class="elsevierStyleHsp" style=""></span>cm H20 and 8.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.1<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>0 aftei a period of treatment with CPAP (p < 0.05). Higher CP AI levels were required by the two patients who gained weight lower or equal levels were required for the two patients whc had lost weight. The variation in CPAP level required did no correlate with the apnea/hypopnea índex, body weight, initia CPAP level or duration of treatment. This study, therefore shows that the mínimum CPAP level required for eliminatin; episodes of apnea decreases after prolonged treatment. Pa tients should thus be encouraged to comply with treatmen and measurement of CPAP levels should be repeated aftei several months of treatment in order to assure that CPAP is at the mínimum level needed for eliminating obstructive apnet during sleep.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Principies and practice of'sleep medicine" "serieFecha" => "1989" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 2 | 7 |
| 2024 October | 34 | 18 | 52 |
| 2024 September | 32 | 15 | 47 |
| 2024 August | 59 | 44 | 103 |
| 2024 July | 26 | 21 | 47 |
| 2024 June | 46 | 18 | 64 |
| 2024 May | 38 | 27 | 65 |
| 2024 April | 24 | 19 | 43 |
| 2024 March | 48 | 34 | 82 |
| 2024 February | 39 | 44 | 83 |
| 2024 January | 0 | 3 | 3 |
| 2023 December | 0 | 2 | 2 |
| 2023 November | 0 | 2 | 2 |
| 2023 October | 0 | 6 | 6 |
| 2023 September | 0 | 1 | 1 |
| 2023 August | 0 | 2 | 2 |
| 2023 July | 0 | 52 | 52 |
| 2023 June | 0 | 2 | 2 |
| 2023 March | 3 | 4 | 7 |
| 2023 February | 34 | 17 | 51 |
| 2023 January | 24 | 26 | 50 |
| 2022 December | 31 | 27 | 58 |
| 2022 November | 33 | 15 | 48 |
| 2022 October | 29 | 32 | 61 |
| 2022 September | 23 | 27 | 50 |
| 2022 August | 38 | 28 | 66 |
| 2022 July | 27 | 42 | 69 |
| 2022 June | 60 | 31 | 91 |
| 2022 May | 55 | 27 | 82 |
| 2022 April | 34 | 27 | 61 |
| 2022 March | 28 | 31 | 59 |
| 2022 February | 30 | 31 | 61 |
| 2022 January | 23 | 25 | 48 |
| 2021 December | 18 | 36 | 54 |
| 2021 November | 18 | 33 | 51 |
| 2021 October | 17 | 27 | 44 |
| 2021 September | 19 | 40 | 59 |
| 2021 August | 17 | 29 | 46 |
| 2021 July | 16 | 30 | 46 |
| 2021 June | 20 | 40 | 60 |
| 2021 May | 21 | 24 | 45 |
| 2021 April | 19 | 37 | 56 |
| 2021 March | 16 | 29 | 45 |
| 2021 February | 13 | 20 | 33 |
| 2021 January | 18 | 28 | 46 |
| 2020 December | 25 | 10 | 35 |
| 2020 November | 13 | 13 | 26 |
| 2020 October | 8 | 8 | 16 |
| 2020 September | 8 | 8 | 16 |
| 2020 August | 28 | 18 | 46 |
| 2020 July | 13 | 14 | 27 |
| 2020 June | 15 | 11 | 26 |
| 2020 May | 7 | 23 | 30 |
| 2020 April | 23 | 12 | 35 |
| 2020 March | 11 | 23 | 34 |
| 2020 February | 23 | 19 | 42 |
| 2020 January | 34 | 27 | 61 |
| 2019 December | 34 | 27 | 61 |
| 2019 November | 11 | 21 | 32 |
| 2019 October | 17 | 648 | 665 |
| 2019 September | 10 | 35 | 45 |
| 2019 August | 16 | 15 | 31 |
| 2019 July | 18 | 31 | 49 |
| 2019 June | 29 | 26 | 55 |
| 2019 May | 18 | 32 | 50 |
| 2019 April | 22 | 47 | 69 |
| 2019 March | 14 | 33 | 47 |
| 2019 February | 11 | 27 | 38 |
| 2019 January | 4 | 24 | 28 |
| 2018 December | 6 | 16 | 22 |
| 2018 November | 17 | 19 | 36 |
| 2018 October | 22 | 11 | 33 |
| 2018 September | 14 | 14 | 28 |
| 2018 May | 8 | 2 | 10 |
| 2018 April | 14 | 18 | 32 |
| 2018 March | 8 | 22 | 30 |
| 2018 February | 7 | 15 | 22 |
| 2018 January | 9 | 13 | 22 |
| 2017 December | 7 | 19 | 26 |
| 2017 November | 9 | 12 | 21 |
| 2017 October | 12 | 15 | 27 |
| 2017 September | 7 | 9 | 16 |
| 2017 August | 13 | 23 | 36 |
| 2017 July | 4 | 9 | 13 |
| 2017 June | 11 | 19 | 30 |
| 2017 May | 11 | 9 | 20 |
| 2017 April | 6 | 16 | 22 |
| 2017 March | 7 | 25 | 32 |
| 2017 February | 1 | 10 | 11 |
| 2017 January | 3 | 14 | 17 |
| 2016 December | 15 | 7 | 22 |
| 2016 November | 17 | 13 | 30 |
| 2016 October | 18 | 18 | 36 |
| 2016 September | 22 | 21 | 43 |
| 2016 August | 15 | 4 | 19 |
| 2016 July | 12 | 6 | 18 |
| 2016 June | 22 | 8 | 30 |
| 2016 May | 18 | 5 | 23 |
| 2016 April | 14 | 0 | 14 |
| 2016 March | 12 | 0 | 12 |
| 2016 February | 16 | 3 | 19 |
| 2016 January | 16 | 5 | 21 |
| 2015 December | 30 | 17 | 47 |
| 2015 November | 25 | 8 | 33 |
| 2015 October | 5 | 1 | 6 |
| 2015 September | 2 | 0 | 2 |
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