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Obstructive sleep apnea (OSA) is a condition characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep. An accessible method to facilitate self-management education is through information and communication technologies (ICTs).To assess the frequency of and preferences for ICT use in patients with sleep apnea.A multicenter, multinational, observational cross-sectional survey study was conducted between 2018 and 2019 in sleep units in different countries of Latin America, including patients of both genders older than 18 years with a diagnosis of sleep apnea. Participants were asked to complete 20 questions in a self-administered survey about the frequency of use of ICTs and their preferences for receiving disease-related information.A total of 435 patients participated in the study, with a mean age of 59.1 ± 14.0; 62.5% (n = 272) were males. Most patients had access to cellphones (92.4%, n = 402), smartphone (83.0%, n = 361) and an internet connection (82.3%, n = 358). One-to-one ICTs were regarded as the most frequently used ICT type, as 75.4% (n = 328) of participants reported using them daily (χ2(4) = 848.207, p =.000). With respect to categories of interest, one-to-one ICTs were also the best rated ICT type to receive (59.1%, n = 257; χ2(2) = 137.710, p =.000) and ask physicians (57.0%, n = 248; χ2(2) = 129.145, p =.000) information about OSA. Finally, older adults and those with lower educational levels were found to be less likely to use and be interested in ICTs.Most patients have access to different ICTs and often use them to seek and receive medical information. The preferred ICTs include those in the one-to-one category (WhatsApp, email) and the one-to-many category (web browsers) for general health and OSA-related information.

Resumen Introduccion La diabetes mellitus (DM), una enfermedad muy frecuente en Mexico, es un factor de riesgo bien conocido para el desarrollo de tuberculosis (TB). Sin embargo, se desconoce en que medida la DM predispone al desarrollo de reacciones adversas (RA) a los farmacos anti-tuberculosis y/o si predispone a un peor resultado en pacientes con pacientes con TB multirresistente (TB-MR) y TB extremadamente resistente (TB-XR). El objetivo principal de este estudio fue describir los resultados del tratamiento anti-tuberculosis, el impacto de la DM y la prevalencia de RA en una cohorte de pacientes con TB pulmonar MR/XR tratados en el centro de referencia nacional para TB, en la Ciudad de Mexico. Resultados Entre 2010 y 2015 se incluyeron 90 pacientes —73 con TB-MR (81,1%), 11 con TB pre-XR (12,2%) y 6 (6,7%) con TB-XR—, 49 (54,4%) de los cuales tenian DM y 3 con co-infeccion por el virus de la inmunodeficiencia humana (VIH) (3,3%). El diagnostico se realizo mediante cultivo y pruebas de farmaco-sensibilidad (PFS) en el 98% de los pacientes y mediante prueba molecular en un caso. La presencia de DM se asocio con un mayor riesgo de RA graves, tales como nefrotoxicidad (odds ratio [OR] = 6,5; intervalo de confianza del 95% [IC 95%]: 1,9-21,8) e hipotiroidismo (OR = 8,8; IC 95%: 1,8-54,2), aunque no con peor resultado del tratamiento. Conclusiones Nuestros datos sugieren que la DM no tiene un impacto sobre los resultados del tratamiento anti-tuberculosis de segunda linea, pero los pacientes con DM tienen mayor riesgo de presentar RA graves secundarias al tratamiento, tales como nefrotoxicidad e hipotiroidismo.

Introduction Diabetes mellitus (DM), a very common disease in Mexico, is a well-known risk factor for tuberculosis (TB). However, it is not known by which extent DM predisposes to adverse events (AE) to anti-TB drugs and/or to worse outcomes in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). The main objective of this study was to describe the outcomes of TB treatment, the impact of DM and the prevalence of AE in a cohort of patients with MDR-/XDR pulmonary TB treated at the national TB referral centre in Mexico City. Results Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (12.2%) and 6 (6.7%) with XDR-TB, including 49 (54.4%) with DM, and 3 with Human Immunodeficiency Virus (HIV) co-infection (3.3%). In 98% of patients, diagnosis was made by culture and drug susceptibility testing, while in a single case the diagnosis was made by a molecular test. The presence of DM was associated with an increased risk of serious drug-related AEs, such as nephrotoxicity (Odds Ratio [OR]=6.5; 95% Confidence Interval [95% CI]: 1.9–21.8) and hypothyroidism (OR=8.8; 95% CI: 1.8–54.2), but not for a worse outcome. Conclusions Our data suggest that DM does not impact second-line TB treatment outcomes, but patients with DM have a higher risk of developing serious AEs to drug-resistant TB treatment, such as nephrotoxicity and hypothyroidism.

Purpose: Information on access and adherence to positive airway pressure (PAP) treatment is lacking at the regional level in Latin America. This study characterized access and adherence to PAP in patients with moderate-severe obstructive sleep apnea (OSA) in Latin America. Methods: Cross-sectional study, conducted at 9 sleep centers across Argentina, Brazil, Chile, Colombia, Mexico, and Peru. Adults diagnosed with moderate-severe OSA (apnea-hypopnea index [AHI] ≥ 15/h) in the previous 12–18 months were eligible. Anthropometrics, health coverage, and OSA severity data were collected. Data on access to therapy, barriers to access, adherence, and factors related to non-compliance were obtained via standardized telephone survey. Results: Eight hundred eighty patients (70% male, 54 ± 13 years, AHI 49 ± 28/h, body mass index 32 ± 7 kg/m2) were included. Four hundred ninety patients (56%) initiated PAP, 70 (14%) discontinued therapy during the first year (mainly due to intolerance), and 420 (48%) were still using PAP when surveyed. Health insurance was private in 36.9% of patients, via the social security system in 31.1%, and via the state in 13.3%, and 18.7% did not have any coverage; 49.5% of patients had to pay all equipment costs. Reasons for not starting PAP were unclear or absent indication (42%), coverage problems (36%), and lack of awareness of OSA burden (14%). Patients with better adherence were older (55.3 ± 13 vs 52 ± 13; p = 0.002) and had more severe OSA (AHI 51.8 ± 27 vs 45.6 ± 27; p = 0.001). Conclusions: Less than half moderate-severe OSA patients started and continue to use PAP. Unclear or absent medical indication and financial limitations were the most relevant factors limiting access to therapy.

Existen diferentes trastornos que afectan el control central de la respiracion y se manifiestan durante el dormir como apneas centrales. Aunque se conoce mucho de la fisiopatologia y etiopatogenia de los diferentes sindromes de apnea central, aun no se han logrado develar todas sus caracteristicas; asimismo, no se conoce la importancia de las neuroinfecciones en la disrupcion de los mecanismos normales del control central de la respiracion durante la noche. A continuacion se presenta el caso de una mujer con afeccion neurologica por enfermedad de Lyme y uso cronico de opioides que causo modificaciones en la homeostasis respiratoria durante el sueno y que se resolvieron con uso de un dispositivo de presion positiva continua en la via aerea

OBJETIVO: Describir el cuadro clínico, evaluar la repercusión de la edad e identificar los factores asociados con la gravedad de la apnea obstructiva del sueño en un grupo de niños preescolares y escolares.MATERIALES Y MÉTODOS: Estudio observacional y retrospectivo, efectuado en niños de 3 a 12 años con apnea obstructiva del sueño, atendidos en el Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, entre el 1 de enero y el 31 de diciembre de 2014. El cuadro clínico se describió con la información contenida en los expedientes; los padres de los niños enviados a la Unidad de Medicina de Sueño respondieron un cuestionario estandarizado de síntomas de sueño y comorbilidades. Para el análisis de la información se utilizó estadística descriptiva. La normalidad de la distribución de los datos se comprobó con la prueba de Kolmogorov Smirnov; las variables dicotómicas se evaluaron con c2 y las variables continuas con t de Student.RESULTADOS: Se revisaron los expedientes de 108 preescolares y 136 escolares. El 74% tuvo hipertrofia de amígdalas. Los síntomas más frecuentes fueron: ronquido habitual, respiración oral nocturna y tos crónica (73, 72 y 70%, respectivamente). Los preescolares tuvieron mayor frecuencia de enfermedad por reflujo gastroesofágico (38 vs 22%) y los escolares mayor obesidad (13 vs 39%) y cardiopatías (4 vs 10%, p < 0.05). La frecuencia de apnea obstructiva del sueño grave fue mayor en preescolares (76 vs 62%, p = 0.01). En los preescolares, el ronquido, las apneas presenciadas, ahogos nocturnos, vigilancia nocturna por los padres y la hipertrofia de amígdalas se asoció con la gravedad de la enfermedad (RM 3.58, 5.92, 5.37, 5.89, 2.17, respectivamente, p < 0.05).CONCLUSIONES: El grupo etario se asocia con diferencias en la manifestación clínica de la apnea obstructiva del sueño, gravedad de la enfermedad y uso del equipo de presión positiva.

Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). However, it is not known to what extent DM affects the outcome in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) treated with second-line anti-TB drugs.The objective of this study was to compare the microbiological evolution (sputum smear and culture conversion) and final outcomes of MDR/XDR-TB patients with and without DM, managed at the national TB reference centre in Mexico City. Results: Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (e.g. MDR-TB with additional resistance to one injectable drug or a fluoroquinolone, 12.2%) and 6 (6.7%) with XDR-TB. Out of these, 49 (54.4%) had DM and 42 (86%) were undergoing insulin treatment.No statistically significant differences were found in treatment outcomes comparing DM vs. non-DM MDR-TB cases: 18/32 (56.3%) of DM cases and 19/24 (79.2%) non DM patients achieved treatment success (p = 0.07). The time to sputum smear and culture conversion was longer (although not statistically) in patients without DM, as follows: the mean (±SD) time to sputum smear conversion was 53.9 (±31.4) days in DM patients and 65.2 (±34.8) days in non-DM ones (p = 0.15), while the time to culture conversion was 66.2 (±27.6) days for DM and 81.4 (±37.7) days for non-DM MDR-TB cases (p = 0.06). Conclusions: The study results support the Mexican National TB programme to strengthen its collaboration with the DM programme, as an entry point for TB (and latent TB infection) screening and management. Keywords: Diabetes mellitus, Delay, Sputum and culture conversion, MDR-TB, High treatment adherence

Introduction: Information concerning the frequency of anxiety and depression symptoms in patients with sleep- disordered breathing (SDB) is controversial. Hence, the objectives of this study were to: determine the frequency of anxiety and depression symptoms in patients with SDB; explore whether the frequency of anxiety and depression symptoms rises with increasing parameters of SDB severity; and investigate the factors potentially associated with anxiety and depression. Materials and Methodology: Data was collected from consecutive adult patients referred to the National Institute of Respiratory Diseases' Sleep Medicine Unit from October 2008 to October 2009. SDB diagnoses were established using standard polysomnography or simplified respiratory polygraphy. All patients routinely completed the Hospital Anxiety and Depression Scale (HADS) on their first visit to the Sleep Medicine Unit. Results: 382 patients with SDB were included. Mean age was 50.8±13.6 years, 62% were male. Anxiety symptoms were acknowledged by 71 patients (18.5%), while 29 (7.6%) had depression symptoms, and 116 (30.4%) had symptoms of anxiety plus depression. Patients who reported anxiety and depression symptoms scored higher on the Epworth Sleepiness Scale (ESS, 16±7) than those with no symptoms (11±6) (p

Obstructive sleep apnea syndrome is a major public health problem. The morphometric model and the Sleep Apnea Clinical Score are widely used to evaluate adults; however, neither of these tools has been validated in a Mexican population.To determine the diagnostic value of the morphometric model and the Sleep Apnea Clinical Score and compare them with conventional clinical instruments.A total of 97 individuals were recruited prospectively. Initial screening excluded 36, of whom nine were subjects without apnea; the remaining 52 were consecutive patients with obstructive sleep apnea syndrome diagnosed by nocturnal polysomnography. Diagnostic values of each test were calculated.Obstructive sleep apnea syndrome patients had significantly higher scores with both instruments than controls: morphometric model: 61.3 (95% CI: 45.5-75.3) vs. 41.0 (95% CI: 35.6-45.6); Sleep Apnea Clinical Score: 45.3 (95% CI: 39.5-40.3) vs. 36 (95% CI: 34.0-36.5), respectively. For severe cases, the best cutoff point for morphometric model was 46, with a sensitivity of 81% (95% CI: 62.5-92.6) and specificity of 46.7% (95% CI: 66.4-100), while for Sleep Apnea Clinical Score it was48, with a sensitivity of 61% (95% CI: 46.1-74.2) and specificity of 80.4% (95% CI: 66-90.6).A morphometric model value of ≥ 46 or an adjusted neck circumference (Sleep Apnea Clinical Score)48 were adequate for diagnosing obstructive sleep apnea syndrome.

Congenital central alveolar hypoventilation syndrome (CCAHS) is a rare sleep-related breathing disorder. Although increasingly frequently diagnosed in sleep clinics and pediatric pulmonology services, its epidemiology is not known. There are about 300 reported cases reported in the literature with an incidence of 1 case per 200,000 live births. CCAHS is characterized by alveolar hypoventilation that occurs or worsens during sleep and is secondary to a reduction/absence of the ventilatory response to hypercapnia and/or hypoxemia. In 90% of the cases it is due to a PARM-type mutation of the PHOX2B gene. Treatment includes mechanical ventilation and diaphragmatic pacemaker. If therapy is not initiated promptly the patient can evolve to chronic respiratory failure, pulmonary hypertension, cor pulmonale and death.In this paper we present three cases of CCAHS diagnosed, treated and followed up at the Sleep Disorders Clinic of the National Institute of Respiratory Diseases in Mexico.Early diagnosis is important to initiate ventilatory support so as to prevent any complications and to reduce mortality.

Background: Treatment failure against Mycobacterium tuberculosis (Mtb) infection has contributed to the development of multidrug resistant (MDR) tuberculosis. Polyfunctional (PF)-T cells secrete IFN-γ+IL-2+TNF-α+ and mediate protective immunity during chronic infections. Objective: characterize and compared the frequency of PF T cells responding to ESAT-6 and PPD antigens. Methods: We followed 10 MDR TB patients longitudinally 3 months after anti-MDR TB treatment. All samples were obtained in accordance with the Institutional Review Board’s protocol. Peripheral blood mononuclear cells (PBMCs) were stimulated with ESAT-6 or PPD and prepared for FACS analysis of CD3, CD4, CD8, IFN-γ, TNF-α and IL-2. Results: Basal samples from all patients showed a positive response to ESAT-6 and PPD antigens; however, the frequency of CD4+ and CD8+ T cells producing any combination of cytokines was not different. The proportion of IFN-γ+TNF-α+IL-2+, IFN-γ+ and TNF-α ESAT-6 CD4+ T cells increased significantly (p=0.02) when compared with pretreatment values. When cells were stimulated with PPD, IFN-γ+TNF-α+, IFN-γ+ and TNF-α+ CD4+ T cells also increased. The frequency of triple positive ESAT-6 CD8+ T cells was not different. For both, ESAT-6 and PPD antigens IFN-γ+TNF-α+, IFN-γ+ and TNF-α+ CD8+ T cells increased significantly (p

To analyze the accuracy and linearity of different CPAP devices outside of the manufacturers' own quality control environment.Accuracy (how well readings agree with the gold standard) and linearity were evaluated by comparing programmed pressure to measured CPAP pressure using an instrument established as the gold standard. Comparisons were made centimeter-by-centimeter (linearity) throughout the entire programming spectrum of each device (from 4 to 20 cm H2O).A total of 108 CPAP devices were tested (1836 measurements); mean use of the devices was 956 hours. Twenty-two of them were new. The intra-class correlation coefficient (ICC) decreased from 0.97 at pressures programmed between 4 and 10 cm H2O, to 0.84 at pressures of 16 to 20 cm H2O. Despite this high ICC, the 95% agreement limit oscillated between -1 and 1 cm H2O. This same behavior was observed in relation to hours of use: the ICC for readings taken on devices with2,000 hours of use was 0.99, while that of the 50 measurements made on devices with6,000 hours was 0.97 (the agreement limit oscillated between -1.3 and 2.5 cm H2O). "Adequate adjustments" were documented in 97% of measurements when the definition was +/- 1 cm H2O of the programmed pressure, but this index of adequate adjustment readings decreased to 85% when the +/- 0.5 cm H2O criterion was applied.In general, the CPAP devices were accurate and linear throughout the spectrum of programmable pressures; however, strategies to assure short- and long-term equipment reliability are required in conditions of routine use.