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OBJETIVO: Evaluar el coste-eficacia de la graduacion automatica de la presion positiva continua de la via aerea (CPAP) en el domicilio, en una y 2 noches consecutivas, en pacientes con sindrome de apneas-hiponeas durante el sueno. PACIENTES Y METODOS: Se practico un estudio de graduacion domiciliaria con un equipo de CPAP automatica (APAP) durante 2 noches consecutivas a 100 pacientes con sindrome de apneas-hipopneas durante el sueno e indicacion de tratamiento con CPAP. Se evaluaron el numero de estudios satisfactorios y el coste resultante de la primera noche y de las 2 noches. Se compararon las necesidades de presion durante cada noche y la concordancia entre la presion seleccionada visualmente por 2 observadores. RESULTADOS: La graduacion de CPAP fue satisfactoria en el 85 y el 80% de los pacientes en la primera y la segunda noches, respectivamente, y en el 88% despues de las 2 noches. No hubo diferencias significativas entre las 2 noches en la presion percentil 95% (media ± desviacion estandar: 10,2 ± 1,8 y 10,2 ± 1,6 cmH2O), la presion media (7,8 ± 1,7 y 7,7 ± 1,7 cmH2O) y la presion visual (9,4 ± 1,5 y 9,4 ± 1,4 cmH2O). Se obtuvo un buen grado de concordancia entre 2 observadores en la seleccion de presion (kappa = 0,956 para la noche 1; kappa = 0,91 para la noche 2). El coste de los estudios fue 232,63 ? para la primera noche y 227,93 ? para las 2 noches consecutivas. CONCLUSIONES: Con un coste similar, la adopcion de un protocolo de graduacion automatica de la CPAP una noche en el domicilio permite incrementar sustancialmente el numero de pacientes estudiados, respecto a 2 noches consecutivas.

Study objectives: To assess predictive factors of quality-of-life (QoL) improvement and continuous positive airway pressure (CPAP) use in patients with sleep apnea-hypopnea syndrome (SAHS) after 1 year of treatment with CPAP. Design: Observational, prospective cohort study. Setting: Sleep unit in a university hospital. Patients: One hundred thirty-three consecutive patients with an indication for CPAP treatment. Measurements and results: Nottingham health profile (NHP) questionnaire, Epworth sleepiness scale score, and objective CPAP use (time counter in the CPAP device) were assessed at baseline and after 3 months and 12 months of CPAP use. Multivariate logistic regression was used to identify predictive factors of CPAP use and improved QoL. At 1 year, 101 patients (76%) were still using CPAP; of these, 88 patients (66%) completed all the follow-up questionnaires. QoL was lower before treatment, compared with the general population, and all dimensions of the NHP, except social isolation, improved significantly from baseline in patients regularly using CPAP, reaching levels comparable to those of the general population at 1 year. Only minimum oxyhemoglobin saturation at diagnostic polysomnography was associated with the degree of QoL improvement at 1 year. Only the NHP and the apnea-hypopnea index (AHI) at baseline were significantly associated with hours of CPAP use at 1 year. Conclusions: Compared to the general population, patients with untreated SAHS had a lower QoL, which improved to the level of the general population after 3 months of CPAP therapy and persisted at 1 year of treatment with CPAP. The only predictor of QoL improvement was minimum nocturnal oxygen saturation at baseline. Higher AHI and worse QoL at baseline were predictors of hours of CPAP use.

Fundamento y objetivo Evaluar el efecto de la septoplastia funcional en un grupo de pacientes con dismorfia septal y sindrome de apnea obstructiva del sueno (SAOS). Pacientes y metodo Se estudio a 34 pacientes con insuficiencia respiratoria nasal y roncopatia cronica desde 1997 hasta 2003. Se confirmo el SAOS mediante estudio polisomnografico nocturno y la dismorfia septal por exploracion otorrinolaringologica. Se estudio la evolucion de los pacientes clinicamente a 1, 3 y 6 meses y con polisomnografia a los 6 meses. Resultados Se evidencio una mejoria objetiva estadisticamente significativa en el indice de apnea-hipoapnea (paso de 45,8 a 31,9; p ≥ 0,05), en la gravedad del SAOS (un 41,2% de los pacientes pasaron a leves o dejaron de tener SAOS), en la saturacion arterial de oxigeno minima media (del 76,4 al 83,1%), asi como una mejoria subjetiva en la escala de Epworth (13 puntos comparado con 6) para la valoracion de la somnolencia y del grado de satisfaccion clinica de los pacientes (el 72% de los pacientes evidenciaron mejoria). Conclusiones La septoplastia funcional es un tratamiento efectivo en pacientes con SAOS y dismorfia septal.

To evaluate the efficacy of functional septoplasty in a group of patients with septal dysmorphy and obstructive sleep apnea syndrome (OSAS).34 patients with nasal respiratory insufficiency and chronic snore were included from 1997 to 2003. All of them were diagnosed of OSAS by nocturnal polysomnography (PSG) and of septal dysmorphy by ORL physical examination. Patients were clinically followed-up at 1, 3 and 6 months after surgery. PSG was also evaluated at 6 months postsurgery.A significant objective reduction of the apnea-hypopnea index (AHI) (45.8 vs 31.9), severity of OSAS, and minimal mean oxygen saturation (76.4 to 83.1) was found. Moreover, we observed a significant improvement of subjective scales of sleepiness (13 vs 6) and the patients' satisfaction degree (72% of patients improved).Functional septoplasty is an effective treatment in patients with OSAS and septal dysmorphy.

The effect of pimozide, a potent and specific blocker of central dopaminergic transmission, upon the sleep of man was studied in six healthy volunteers. Given at doses of 1 and 4 mg, which have clear central effects in humans, pimozide produced only minor changes in the EEG patterns of sleep. At these doses a slight and non-significant decrease in phase I sleep was observed, while phases W, II, III, IV and REM were not modified. No differences were noted between drug or post-treatment and control nights in total NREM sleep, total REM sleep, number of episodes of REM or total number of eye movements. An increase in REM sleep in the first third of the second pimozide night and an increase in the duration of the first REM period in the first drug night were the only statistically significant findings. If one accepts that central effects seen in man after pimozide given in conditions similar to those of this study are due to dopaminergic blockade, our results tend to suggest that dopamine is, at most, of rather minor importance in the physiology of sleep in man.