Case Reports
Acute Confusional Syndrome Associated With Obstructive Sleep Apnea Aggravated by Acidosis Secondary to Oral Acetazolamide Treatment
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Montiel, M. Mayos" "autores" => array:5 [ 0 => array:3 [ "nombre" => "E." "apellidos" => "Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Güell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Antón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "J.A." "apellidos" => "Montiel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 4 => array:5 [ "preGrado" => "Dra" "nombre" => "M." "apellidos" => "Mayos" "email" => array:1 [ 0 => "mmayos@hsp.santpau.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Neumología, Hospital de la Santa Creu i de Sant Pau, Barcelona. Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Interna, Hospital de la Santa Creu i de Sant Pau, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dra. M. Mayos. Departamento de Neumología. Hospital de la Santa Creu i de Sant Pau. Sant Antoni M. Claret, 167. 08025 Barcelona. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-11-04" "fechaAceptado" => "2003-12-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec153445" "palabras" => array:5 [ 0 => "Acute confusional syndrome" 1 => "Delirium" 2 => "Obstructive sleep apnea syndrome" 3 => "Metabolic acidosis" 4 => "Acetazolamide" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153444" "palabras" => array:5 [ 0 => "Síndrome confusional agudo" 1 => "Delirium" 2 => "Síndrome de apnea-hipopnea obstructiva del sueño" 3 => "Acidosis metabólica" 4 => "Acetazolamida" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Acute confusional syndrome, or delirium, is a transitory mental state characterized by the fluctuating alteration of awareness and attention levels. We present the case of a patient with acute confusional syndrome associated with obstructive sleep apnea syndrome (OSAS) aggravated by metabolic acidosis induced by oral acetazolamide treatment.</p><p class="elsevierStyleSimplePara elsevierViewall">A 70-year-old man with no history of neurological disease was referred with a clinical picture consistent with acute confusional syndrome presenting between midnight and dawn. During the admission examination infectious, toxic, and neurologic causes, or those related to metabolic or heart disease were ruled out. Arterial blood gases measured during one of the nighttime episodes of acute confusional syndrome showed mild hypoxia and hypercapnia with mixed acidosis. Signs and symptoms suggestive of OSAS had been developing over the months prior to admission, with snoring, sleep apnea, and moderate daytime drowsiness. Polysomnography demonstrated severe OSAS with an apnea-hypopnea index of 38. Mean arterial oxygen saturation was 83%; time oxygen saturation remained below 90% was 44%. The attending physician ordered the withdrawal of oral acetazolamide, which was considered the cause of the metabolic component of acidosis. Treatment with continuous positive airway pressure was initiated at 9 cm H<span class="elsevierStyleInf">2</span>O after a titration polysomnographic study. The patient continued to improve.</p><p class="elsevierStyleSimplePara elsevierViewall">OSAS, for which very effective treatment is available, should be included among diseases that may trigger acute confusional syndrome.</p>" ] "es" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">El síndrome confusional agudo o <span class="elsevierStyleItalic">delirium</span> es un trastorno transitorio del estado mental caracterizado por la alteración fluctuante del nivel de conciencia y atención. Presentamos el caso de un paciente con síndrome confusional agudo asociado a síndrome apnea-hipopnea obstructiva del sueño (SA-HOS), agravado por una acidosis metabólica secundaria al tratamiento con acezatolamida.</p><p class="elsevierStyleSimplePara elsevierViewall">Se trataba de un varón de 70 años de edad, sin antecedentes de enfermedad neurológica previa, remitido por un cuadro confusional agudo de inicio en la madrugada. Durante el ingreso se descartaron causas de origen infeccioso, tóxico, neurológico o secundarias a enfermedad metabólica o cardíaca. Los gases arteriales obtenidos en la madrugada durante uno de los episodios de síndrome confusional agudo mostraron una ligera hipoxia e hipercapnia con acidosis de tipo mixto. El paciente había presentado en los meses previos al ingreso síntomas indicativos de SAHOS (ronquido, pausas respiratorias durante el sueño y somnolencia diurna moderada). Se efectuó una polisomnografía diagnóstica que puso de manifiesto un SAHOS de carácter grave. El índice de ap-nea-hipopnea/h era de 38, la saturación de oxígeno media del 83% y el tiempo de saturación de oxígeno por debajo del 90%, del 44%. Se retiró la acetazolamida oral, que se consi-deró la causa del componente metabólico de la acidosis, y tras un nuevo estudio polisomnográfico de titulación se inició tratamiento con presión continua en la vía aérea a 9 cmH<span class="elsevierStyleInf">2</span>O. El paciente siguió un curso clínico favorable.</p><p class="elsevierStyleSimplePara elsevierViewall">El SAHOS, entidad con un tratamiento muy eficaz, ha de incluirse entre las enfermedades que pueden precipitar un síndrome confusional agudo.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía diagnóstica y terapéutica del síndrome confusional agudo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J Tejeiro" 1 => "B Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2002" "volumen" => "202" "paginaInicial" => "280" "paginaFinal" => "288" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12060545" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delirium: optimising management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "DJ Meagher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2001" "volumen" => "322" "paginaInicial" => "144" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11159573" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome confusional en el anciano" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S Altimir" 1 => "M Prats" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2002" "volumen" => "119" "paginaInicial" => "386" "paginaFinal" => "389" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delirium" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "TM Brown" 1 => "MF Boyle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2002" "volumen" => "325" "paginaInicial" => "644" "paginaFinal" => "647" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12242179" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructive sleep apnea presenting as acute delirium" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "JF Whitney" 1 => "DE Gannon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0735-6757(96)90174-6" "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "1996" "volumen" => "14" "paginaInicial" => "270" "paginaFinal" => "271" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8639200" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute delirium as a manifestation of obstructive sleep apnea syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "X Muñoz" 1 => "S Martí" 2 => "J Sumalla" 3 => "J Bosch" 4 => "G Sampol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/ajrccm.158.4.9801005" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "1998" "volumen" => "158" "paginaInicial" => "1306" "paginaFinal" => "1307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9769297" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central sleep apnea. 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| 2013 July | 62 | 22 | 84 |
| 2013 June | 34 | 8 | 42 |
| 2013 May | 37 | 7 | 44 |
| 2013 April | 37 | 5 | 42 |
| 2013 March | 11 | 3 | 14 |
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