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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The relationship between sleep-disordered breathing and cardiovascular disease has now been clearly identified&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Part of the cardiovascular impact is attributable to chronic intermittent hypoxia<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> generating oxygen free radicals which trigger the inflammatory cascade by promoting a state of systemic inflammation that leads to widespread endothelial damage&#44; thus predisposing toward atherosclerosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The severity of these disorders is evaluated using the apnea&#8211;hypopnea index &#40;AHI&#41;&#44; defined by the number of apnea and hypopnea events per hour of sleep using polysomnography as a diagnostic method&#44; and per hour of recording&#44; if respiratory polygraphy is used&#46; Apneas are defined by a reduction in airflow of at least 90&#37; with a duration of at least 10<span class="elsevierStyleHsp" style=""></span>s&#46; Hypopnea occurs when airflow is reduced by at least 30&#37; for at least 10<span class="elsevierStyleHsp" style=""></span>s&#44; in association with arterial oxygen desaturation of 3&#37; or more&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> This raises the first question&#58; is the pathophysiological impact of both parameters the same&#63; Do they represent the same thing&#63; Is it acceptable to combine them in the same index&#63;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a cohort of 963 patients with stable heart failure&#44; 58&#37; had moderate to severe apnea&#44; and mortality during a follow-up of 7&#46;3 years was 50&#37;&#46; The percentage of time during sleep with an oxygen saturation below 90&#37; &#40;T90&#41; was significantly associated with mortality&#44; which increased by 16&#37; for every hour that the patient showed a saturation of less than 90&#37;&#46; This relationship was not observed with the AHI&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Obviously&#44; the presence of apnea and hypopnea define the presence of the disease&#44; but is this ratio useful for stratifying their severity&#63; Is it an appropriate representation of the pathophysiological mechanisms that potentially contribute to the increased risk of cardiovascular disease in these patients&#63; Probably not&#44; since a higher degree of hypoxemia will surely have greater negative effects&#59; but the AHI ignores this&#44; and does not reflect either the depth or the duration of desaturations and therefore would classify patients with different T90 values&#44; desaturations or comorbidities but with the same AHI in the same severity group&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">It was recently reported that the severity of obstructive sleep apnea&#44; quantified by the hypoxic burden associated with the respiratory event&#44; was independently associated with cardiovascular mortality&#46; In contrast&#44; there was no association between this and AHI when it was evaluated as an independent predictor&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Excessive daytime sleepiness&#44; on the other hand&#44; is a symptom that indicates the clinical severity of obstructive sleep apnea&#46; However&#44; patients may have worse oxygenation indices and longer apneas than those without this symptom&#44; despite having a similar AHI&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This evidence suggests that when stratifying disease severity&#44; we must set aside our one-dimensional vision that only considers AHI&#44; and instead take into account other parameters that reflect the overall status of the patient&#44; and include those that reflect the hypoxemic burden of the disease&#44; which is ultimately responsible for cardiovascular morbidity and mortality&#46; It would be interesting to combine efforts to develop a similar tool to the BODE index in COPD that would provide an overall assessment of patients with sleep disordered breathing&#46;</p></span>"
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Letter to the Editor
Sleep-Disordered Breathing: Looking Beyond the Apnea/Hypopnea Index
Trastornos respiratorios del sueño: más allá del índice apneas e hipopneas
Fernando Astur Camporroa,
Corresponding author
fercam02@hotmail.com

Corresponding author.
, Gregorio V. Kevorkofa, Daniel Alvarezb
a Servicio de Neumología, Clínica Universitaria Reina Fabiola, Córdoba, Argentina
b Servicio de Neurología, Clínica Universitaria Reina Fabiola, Córdoba, Argentina
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The relationship between sleep-disordered breathing and cardiovascular disease has now been clearly identified&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Part of the cardiovascular impact is attributable to chronic intermittent hypoxia<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> generating oxygen free radicals which trigger the inflammatory cascade by promoting a state of systemic inflammation that leads to widespread endothelial damage&#44; thus predisposing toward atherosclerosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The severity of these disorders is evaluated using the apnea&#8211;hypopnea index &#40;AHI&#41;&#44; defined by the number of apnea and hypopnea events per hour of sleep using polysomnography as a diagnostic method&#44; and per hour of recording&#44; if respiratory polygraphy is used&#46; Apneas are defined by a reduction in airflow of at least 90&#37; with a duration of at least 10<span class="elsevierStyleHsp" style=""></span>s&#46; Hypopnea occurs when airflow is reduced by at least 30&#37; for at least 10<span class="elsevierStyleHsp" style=""></span>s&#44; in association with arterial oxygen desaturation of 3&#37; or more&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> This raises the first question&#58; is the pathophysiological impact of both parameters the same&#63; Do they represent the same thing&#63; Is it acceptable to combine them in the same index&#63;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In a cohort of 963 patients with stable heart failure&#44; 58&#37; had moderate to severe apnea&#44; and mortality during a follow-up of 7&#46;3 years was 50&#37;&#46; The percentage of time during sleep with an oxygen saturation below 90&#37; &#40;T90&#41; was significantly associated with mortality&#44; which increased by 16&#37; for every hour that the patient showed a saturation of less than 90&#37;&#46; This relationship was not observed with the AHI&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Obviously&#44; the presence of apnea and hypopnea define the presence of the disease&#44; but is this ratio useful for stratifying their severity&#63; Is it an appropriate representation of the pathophysiological mechanisms that potentially contribute to the increased risk of cardiovascular disease in these patients&#63; Probably not&#44; since a higher degree of hypoxemia will surely have greater negative effects&#59; but the AHI ignores this&#44; and does not reflect either the depth or the duration of desaturations and therefore would classify patients with different T90 values&#44; desaturations or comorbidities but with the same AHI in the same severity group&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">It was recently reported that the severity of obstructive sleep apnea&#44; quantified by the hypoxic burden associated with the respiratory event&#44; was independently associated with cardiovascular mortality&#46; In contrast&#44; there was no association between this and AHI when it was evaluated as an independent predictor&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Excessive daytime sleepiness&#44; on the other hand&#44; is a symptom that indicates the clinical severity of obstructive sleep apnea&#46; However&#44; patients may have worse oxygenation indices and longer apneas than those without this symptom&#44; despite having a similar AHI&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">This evidence suggests that when stratifying disease severity&#44; we must set aside our one-dimensional vision that only considers AHI&#44; and instead take into account other parameters that reflect the overall status of the patient&#44; and include those that reflect the hypoxemic burden of the disease&#44; which is ultimately responsible for cardiovascular morbidity and mortality&#46; It would be interesting to combine efforts to develop a similar tool to the BODE index in COPD that would provide an overall assessment of patients with sleep disordered breathing&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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