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Objective: To describe the architecture of sleep, breathing events and oxygenation in a selected population of patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea-hypopnoea syndrome (OSAHS) in Burgos (800 m) and Bogota (2640 m). Methodology: Study, retrospective. Patients with a diagnosis of stable COPD who underwent a polysomnography at the Hospital Universitario de Burgos (HUBU) or Fundación Neumológica Colombiana (FNC). Databases of patients of both institutions, medical records and the results of baseline polysomnography, spirometry and arterial blood gases were reviewed, collecting variables related to sleep architecture, respiratory events and oxygenation. Results: Patients Burgos: n 17, 94.1% male, age 63.2 ± 8.8 years, BMI 31.28 ± 5.5 kg / m2. Spirometry FVC: 2.84 ± 0.9 liters (64.19 ± 17%), FEV1: 1.86 ± 0.7 liters (57.26 ± 18.2%), FEV1 / FVC 62.8 ± 6.6. Low sleep efficiency. Low percentage of NREM and REM. IAH 33.4 (IQR 16.2 to 65.2). Percentage of time with SpO2

Indoleamine 2,3-dioxygenase (IDO) is an intracellular and extrahepatic enzyme predominantly found in many cells, especially macrophages. Tryptophan degradation generates kynurenine, and this pathway of tryptophan metabolism is an effective mechanism for modulating the immune response. The IDO facilitates immune tolerance and is one of the main actors involved in the inhibition of cell proliferation, including activated T cells. IDO induces production of reactive oxygen species (ROS) and nitric oxide (NO) radicals. Several pathways involved in the regulation of immune response are regulated by redox mechanisms. Reactive oxygen and nitrogen species (ROS-RNS) and other redox active molecules play key roles in immunity.

SUMMARY: Indoleamine 2,3-dioxygenase (IDO) is an intracellular and extrahepatic enzyme predominantly found in many cells, especially macrophages. Tryptophan degradation generates kynurenine, and this pathway of tryptophan metabolism is an effective mechanism for modulating the immune response. The IDO facilitates immune tolerance and is one of the main actors involved in the inhibition of cell proliferation, including activated T cells. IDO induces production of reactive oxygen species (ROS) and nitric oxide (NO) radicals. Several pathways involved in the regulation of immune response are regulated by redox mechanisms. Reactive oxygen and nitrogen species (ROS-RNS) and other redox active molecules play key roles in immunity.

SUMMARY:Sleep disordered breathing (SDB) is a common condition in children. Sleep Apnea/Hypopnea syndrome (SAHS) in children is a frequent sleep disorder, with a prevalence estimated to be 1 - 3% of all children. The most frequent cause of SAHS in children is the adenotonsillar hypertrophy. SAHS in children can result in severe complications if left untreated such as impaired physical growth, delayed development, poor school performance and in severe cases, hypertension and cor pulmonale, nevertheless, yet it is an under recognized condition. The gold standard diagnostic technique is the nocturnal polysomnography (PSG), guidelines for performing laboratory-based polysomnography in children have been established, the sleep laboratory should be a nonthreatening environment and personnel with pediatric training should record, score and interpret the study. The diagnostic criteria for SAHS in adults is not useful for diagnosis of SAHS in children. Adenotonsillectomy is the most common treatment for children with SAHS.RESUMEN:Los trastornos respiratorios del sueño en los niños, en particular el Síndrome de Apneas/Hipopneas durante el sueño (SAHS), es una patología frecuente, que afecta entre el 1 - 3% de la población infantil, siendo su causa más frecuente la hipertrofia adenoamigdalar. Es una enfermedad infradiagnosticada y que conlleva importantes complicaciones como son alteraciones del crecimiento, alteraciones cognitivas e incluso en casos severos Cor Pulmonale. La polisomnografía nocturna (PSG), es la técnica diagnóstica de elección para el diagnóstico del SAHS en los niños, pero en la población infantil es necesario tener en cuenta una serie de consideraciones, como son la edad de la población que se estudia, entorno adecuado y la necesidad de técnicos entrenados en el cuidado de los niños. Los criterios diagnósticos del SAHS para adultos no son útiles en los niños. El tratamiento de elección en los niños con SAHS es la adenoamigdalectomia.

SUMMARYRecent studies associate SAHS with higher cardiovascular morbidity-mortality and we know that even today SAHS continues to be under-diagnosed. This under-diagnosis, signifies, on the one hand, a lowering or loss of health, and on the other, an increase in costs, since it has been demonstrated that patients with undiagnosed or untreated SAHS are higher consumers of health service resources and have higher work absenteeism, while these costs are reduced in SAHS patients treated with CPAP. Therefore, we find ourselves faced with the need to diagnose and suitably treat the largest possible number of patients who suffer from SAHS.The diagnostic method of choice continues to be supervised nocturnal PSG in the sleep laboratory, however, the future of SAHS diagnosis is inevitably moving towards the use of simplified systems with a high sensitivity and specificity. In this sense, the Respiratory Polygraphy represents an alternative tool for the diagnosis of SAHS, being able to be carried out in the home of the patient, just like the Auto-CPAP systems. Thus, the current approach to SAHS has changed and therefore, a patient with a high probability of suffering from SAHS, is able to have a RP carried out at home which might diagnose SAHS and later to have the CPAP adjusted to the optimum pressure level, as a recording using Auto-CPAP, could be carried out at home.With this new approach to SAHS, waiting lists could be reduced and thus reduce the under-diagnosis. All this brings about an implicit saving of resources. The place of diagnosis will basically be the home, and in this sense, the development of telematic applications will contribute significantly to the modification of diagnostic strategies.The success of this form of approach to SAHS, will be established with a suitable selection of subsidiary diagnosed patients and adjustment of home treatment, therefore, each sleep unit must set up its own diagnostic-therapeutic strategy which may be more cost effective.

RESUMEN:Estudios recientes, relacionan el SAHS con mayor morbimortalidad cardiovascular y por otro lado, sabemos que aún hoy en día, el SAHS sigue estando infradiagnosticado. Este infradiagnóstico supone, por un lado, un déficit o perdida de salud y por otro lado, un aumento de costes, ya que está demostrado que los pacientes con SAHS no diagnosticados ni tratados, son mayores consumidores de los servicios de salud y presentan mayor absentismo laboral, mientras que estos costes se reducen en los pacientes con SAHS tratados con CPAP. Por tanto, nos encontramos ante la necesidad de diagnosticar y tratar adecuadamente al mayor número posible de pacientes que padezcan un SAHS.El método diagnóstico de elección, sigue siendo la PSG nocturna vigilada en el laboratorio de sueño, sin embargo, el futuro del diagnóstico del SAHS pasa indefectiblemente por el empleo de sistemas simplificados con alta sensibilidad y especificidad. En este sentido, la Poligrafía Respiratoria, representa una alternativa útil para el diagnóstico del SAHS, pudiendo ser realizada en el domicilio del paciente, al igual que los sistemas Auto-CPAP. De esta forma, el abordaje actual del SAHS ha cambiado y así, un paciente con alta probabilidad de padecer un SAHS, se le puede realizar una PR domiciliaria que diagnostique el SAHS y posteriormente para ajustar el nivel de presión óptima de CPAP, se le podría hacer un registro domiciliario de Auto-CPAP.Con este nuevo abordaje del SAHS, se podrán disminuir las listas de espera y por tanto disminuir el infradiagnóstico. Todo ello conlleva implícitamente un ahorro de recursos. El lugar del diagnóstico, será fundamentalmente el domicilio, y en este sentido, el desarrollo de aplicaciones telemáticas contribuirá de forma importante a la modificación de las estrategias diagnósticas.El éxito de esta forma de abordaje del SAHS, vendrá marcado por una adecuada selección de los pacientes subsidiarios de diagnóstico y ajuste de tratamiento domiciliario, por lo cual, cada unidad de sueño debe establecer su propia estrategia diagnóstico-terapeútica que resulte más costo-efectivaSUMMARYThe recent studies relate the Sleep Apnea/Hipopnea Syndrome (SAHS) with cardiovascular morbidity and mortality, and today, we know it is an underdiagnosed disease. This underdiagnostic implies unhealthy and it increases of health care utilization because the patients with SAHS neither diagnostic nor treatment, they are increase health care utilization and they are more absentees work, whereas the Continuous Positive Airway Pressure (CPAP) treatment significantly reduces health care utilization. So, we must diagnose and we must treat the patients with SAHS.The nocturnal polysomnography (PSG) is still the diagnosis technique considered as "Gold Standard", although in the future, the diagnosis of SAHS will be to do it with simplifies systems with highly sensitivity and with highly specificity. The Respiratory Polygraphy (RP) is a useful option for diagnosis of SAHS and the Respiratory Polygraphy and the auto-CPAP system could be makes at home. In this moment, when we find a patient with highly probability to have SAHS, we could make a Respiratory Polygraphy at home for diagnosis of SAHS and then, we could make auto-CPAP for titration the optimum level of CPAP pressure.With this approach, we will reduce the underdiagnostic and the waiting list, and then saving resources. The place of diagnosis will be at home and then the telematic development will aid to modify the diagnostic approach.This approach's success for diagnose of SAHS will be determinate for the patients´s suitable selection, so every sleep unit must set up its diagnostic-treatment approach that results more cost-effective