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Background: A lot of studies reported a link between air pollutants and negative health effects, which leads to an increased hospital admissions and outpatient visits. Several factors influence the exposure to intra-urban air pollution, such as traffic and climate. Aims-Objectives: To assess the influenceof air pollutants on total respiratory-related hospital admissions in a 1-year period in Valladolid, Spain. Methods: Hospital admissions in our Pneumology service throughout 2015 were retrospectively analyzed. Correlations between hospital admissions, air pollution data from the week prior to hospital admission(PM10, PM2.5, NO2 and O3 1-week lag), gender and diagnosis-related groups(GRDs) were analyzed by descriptive stadistic, linear correlation and regression, and stratified by trimester to adjust the seasonality of hospital admissions. Results: A total of 999 hospital admissions were analyzed(62.5% males;average age of 70±15.3 years old). The most frequent GRDs were pneumonia(44.8%) and COPD(7.6%). Mean of hospital admissions: daily 2.63 (SD 2.05), weekly 17.96 (SD 8.26) and weekly stratifying by seasons ranged between 27.6(SD 8.55) and 13.30(SD 5.08). The weekly averaged levels of pollutants were PM10 17.81(SD 7.07), PM2.5 11.53(SD 6.3), NO2 24.7(SD 8.3) and O3 48.45(SD 21.6). Weekly, the levels of PM10 and PM2.5 exceeded the limits recommended by WHO(36.5% and 42.3%, respectively). The pollutant levels were not significantly correlated with the number of admissions, neither after stratifying by seasons nor after adjusting for confounding factors. Conclusion: PM10, PM2.5, NO2 and O3 levels in the previous week were not linked with an increased number of respiratory-related hospital admissions in Valladolid.

Objective: To assess the effect of continuous positive airway pressure (CPAP) on blood pressure (BP), glucose and lipid profile, in women with moderate-to-severe obstructive sleep apnoea (OSA). Methods: We conducted a multicentre, open-label, randomized controlled trial in 307 consecutive women diagnosed with moderate-to-severe OSA (apnoea-hypopnoea index ≥15) in 19 Spanish Sleep Units. Women were randomized to receive effective CPAP (n=151) or conservative treatment (n=156) for 3 months. Systolic (SBP) and diastolic office BP (DBP), fasting glucose, glycated haemoglobin (HbA1c), insulin resistance measured by the homeostasis model assessment (HOMA) and total, LDL and HDL cholesterol were assessed at baseline and at the end of the follow-up. Data were analysed on an intention-to-treat basis, with adjustment for baseline values, body mass index, age, and specific medical treatment. The results are expressed as adjusted intergroup changes (95%CI). Results: Women had a mean (SD) age 57.1 (10.1) years, body mass index 34.3 (7.0) Kg/m2, ESS 9.8 (4.4) and apnoea-hypopnoea index 38.6 (20.8). Compared to the control group, the CPAP group achieved a significantly greater improvement in DBP (mean difference -2.04 mmHg; 95%CI -4.02 to -0.05; p=0.045), and a non-significant improvement in SBP (mean difference -1.54 mmHg, 95%CI -4.58 to 1.51; p=0.32). No differences were shown in fasting glucose, HbA1c, HOMA, and cholesterol measures between groups. Conclusion: In women with moderate-to-severe OSA, 3 months of CPAP therapy improves BP, but not the glucose and lipid profile, compared to conservative treatment.

Background. The development of home-based screening tests in sleep apnoea-hypopnoea syndrome (SAHS) diagnosis is essential to increase the accessibility to diagnostic facilities. Chronic obstructive pulmonary disease (COPD) is very prevalent among SAHS patients. However, almost all studies assessing home-based screening tests for SAHS excluded patients with COPD. Objectives. To assess the influence of suffering from COPD in the diagnostic performance of an at-home screening test for moderate-to-severe SAHS based on automated analysis of nocturnal oximetry by means of a multilayer perceptron neural network (MLP-NN). Methods. All patients showed moderate-to-high suspicion of suffering from SAHS. The population was divided into a training set (193) and two test sets (NO COPD: 110, COPD: 68). In-laboratory PSG was the gold standard. All patients carried out unsupervised nocturnal oximetry at home. Statistical, spectral and nonlinear features were computed and fed a regression MLP-NN trained to estimate the AHI. Results. The MLP-NN achieved similar concordance (intra-class correlation) between actual and estimated AHI in both NO COPD (0.73) and COPD (0.79) groups. The MLP-NN achieved high sensitivity values both in the NO COPD (97.5%, 80.9%) and in the COPD (86.5%, 84.6%) test sets for the cut-offs 15 and 30 events per hour, respectively. The MLP-NN reached lower specificity both in the NO COPD (24.1%, 70.2%) and in the COPD (37.5%, 69.0%) populations. Conclusions. Suffering from COPD does not affect the performance of a MLP-NN in the diagnosis of moderate-to-severe SAHS using unsupervised nocturnal oximetry at patient9s home.

Background. Paediatric obstructive sleep apnoea-hypopnoea syndrome (OSAHS) has emerged as a frequent and concerning medical condition in the past 2-3 decades. In-laboratory overnight polysomnography (PSG) is the gold standard diagnostic technique but is complex and relatively inaccessible. Objectives. Blood oxygen saturation (SpO 2 ) from nocturnal oximetry could provide essential information in order to simplify the diagnostic process. The goal of this study was to design and assess an automated classifier aimed at detecting OSAHS. Methods. The population under study was composed of 176 children referred to the Sleep Unit due to suspected OSAHS. All children underwent complete in-laboratory PSG as gold standard. An apnoea-hypopnoea index (AHI) greater than or equal to 5 e/h were considered OSAHS positive. The population was randomly divided into training set (60%) and test set (40%). SpO 2 recordings from PSG were processed offline. Three nonlinear measures were derived from nocturnal SpO 2 recordings and used to design a support vector machine (SVM) classifier. Conventional oxygen desaturation index of 3% (ODI3) was used for comparison purposes. Results. The SVM classifier reached 85.7% sensitivity, 81.0% specificity, 4.50 LR+, 0.18 LR-, and 82.9% accuracy in the test set. On the contrary, ODI3 achieved 89.3% sensitivity, 69.1% specificity, 2.89 LR+, 0.16 LR-, and 77.1% accuracy in the same test set. Conclusions. The proposed SVM classifier outperforms the conventional desaturation index ODI3. Therefore, SVMs and nonlinear measures could provide useful tools to assist in the diagnosis of paediatric OSAHS.

Carlos Zamarrón1, Vanesa García Paz1, Emilio Morete1, Felix del Campo Matías21Servicio de Neumología, Hospital Clínico Universitario de Santiago, Santiago, Spain; 2Servicio de Neumologia, Hospital Universitario Rio Ortega de Vallaclolid, Vallaclolid, SpainAbstract: Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two diseases that often coexist within an individual. This coexistence is known as overlap syndrome and is the result of chance rather than a pathophysiological link. Although there are claims of a very high incidence of OSAS in COPD patients, recent studies report that it is similar to the general population. Overlap patients present sleep-disordered breathing associated to upper and lower airway obstruction and a reduction in respiratory drive. These patients present unique characteristics, which set them apart from either COPD or OSAS patients. COPD and OSAS are independent risk factors for cardiovascular events and their coexistence in overlap syndrome probably increases this risk. The mechanisms underlying cardiovascular risk are still unclear, but may involve systemic inflammation, endothelial dysfunction, and tonic elevation of sympathetic neural activity. The treatment of choice for overlap syndrome in stable patients is CPAP with supplemental oxygen for correction of upper airway obstructive episodes and hypoxemia during sleep.Keywords: chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, overlap syndrome, sleep, cardiovascular disease

BACKGROUND The safe and appropriate use of long-acting beta-agonists (LABAs) for the treatment of asthma has been widely debated. In two large clinical trials, investigators found a potential risk of serious asthma-related events associated with LABAs. This study was designed to evaluate the risk of administering the LABA salmeterol in combination with an inhaled glucocorticoid, fluticasone propionate. METHODS In this multicenter, randomized, double-blind trial, adolescent and adult patients (age, ≥12 years) with persistent asthma were assigned to receive either fluticasone with salmeterol or fluticasone alone for 26 weeks. All the patients had a history of a severe asthma exacerbation in the year before randomization but not during the previous month. Patients were excluded from the trial if they had a history of lifethreatening or unstable asthma. The primary safety end point was the first serious asthma-related event (death, endotracheal intubation, or hospitalization). Noninferiority of fluticasone–salmeterol to fluticasone alone was defined as an upper boundary of the 95% confidence interval for the risk of the primary safety end point of less than 2.0. The efficacy end point was the first severe asthma exacerbation. RESULTS Of 11,679 patients who were enrolled, 67 had 74 serious asthma-related events, with 36 events in 34 patients in the fluticasone–salmeterol group and 38 events in 33 patients in the fluticasone-only group. The hazard ratio for a serious asthmarelated event in the fluticasone–salmeterol group was 1.03 (95% confidence interval [CI], 0.64 to 1.66), and noninferiority was achieved (P = 0.003). There were no asthma-related deaths; 2 patients in the fluticasone-only group underwent asthmarelated intubation. The risk of a severe asthma exacerbation was 21% lower in the fluticasone–salmeterol group than in the fluticasone-only group (hazard ratio, 0.79; 95% CI, 0.70 to 0.89), with at least one severe asthma exacerbation occurring in 480 of 5834 patients (8%) in the fluticasone–salmeterol group, as compared with 597 of 5845 patients (10%) in the fluticasone-only group (P

Con la evidencia cientifica actual, se puede afirmar que el sindrome de apnea-hipopnea del sueno (SAHS), provoca un impacto negativo en la mayoria de los ambitos de la vida diaria, tanto a corto, como a largo plazo. Se han descrito ampliamente en la literatura su asociacion con enfermedades cardiovasculares, metabolicas, asi como su relacion con un deterioro en la esfera cognitiva, y en la misma linea, el impacto que tiene en relacion con una mayor siniestralidad, especialmente en referencia a los accidentes de trafico. El SAHS conlleva una disminucion de la calidad de vida, y de la motivacion para mantener un estilo de vida saludable, asi como un posible menor cumplimiento terapeutico de las comorbilidades asociadas1. Sin embargo, las repercusiones sobre la actividad laboral de estos pacientes apenas han sido estudiadas2,3, a pesar de sus consecuencias economicas4. Las implicaciones del SAHS sobre la actividad laboral estan siendo evaluadas en la literatura en relacion con muy diversos aspectos: la incapacidad laboral transitoria, la valoracion de la discapacidad, la disminucion de la productividad laboral, el estres, la insatisfaccion en el puesto de trabajo, el sindrome burnout y el posible riesgo de accidentes laborales2,5. Aunque, no todos los estudios son coincidentes en sus conclusiones, se ha puesto en evidencia que estos pacientes muestran una disminucion de la eficiencia en el trabajo y una mayor probabilidad de siniestralidad laboral. Un estudio prospectivo finlandes, muestra la magnitud del problema, estimando que el SAHS puede duplicar el riesgo de absentismo laboral, tanto en varones como en mujeres6. Recientemente, Jurado-Gamez et al.7 evidencian que los pacientes con SAHS presentan un aumento de bajas laborales superiores a 30 dias

Felix del Campo Matias1, Tomas Ruiz Albi2 and Carlos Zamarron Sanz3 1Division of Respiratory Medicine, Hospital Universitario Rio Hortega, Departament of Medicine, Universidad de Valladolid,Valladolid 2Division of Respiratory Medicine, Hospital Universitario Rio Hortega, Valladolid, 3Division of Respiratory Medicine Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain

Though clinically recognized for more than four decades (Gastaut et al., 1965), general awareness of OSAS has been slow to develop. OSAS has been associated with cardiovascular disease (Marin et al., 2005; Duran-Cantolla et al., 2010; Barbe et al., 2010), automobile accidents (Teran-Santos et al., 1999), chronic obstructive pulmonary disease (Chaouat et al., 1995), heart failure (Oldenburg et al., 2007) and health related quality of life deterioration (Pichel et al., 2004). OSAS often coexists with obesity and has been related to insulin resistance and metabolic syndrome (Choi et al., 2008).

Se describe el caso de un varon de 67 anos sometido a reseccion transuretral e inmunoterapia con bacilo de Calmette-Guerin (BCG) por presentar un carcinoma transicional superficial de vejiga. Tras varias sesiones de instilacion intravesical del preparado (BCG), el paciente desarrollo un cuadro de fiebre, astenia y anorexia persistente que motivo su ingreso hospitalario. Se realizaron diversas pruebas, estableciendose el diagnostico de diseminacion miliar por BCG, que evoluciono fatalmente, a pesar del tratamiento tuberculostatico. La administracion intravesical de BCG rara vez origina complicaciones graves por diseminacion hematogena aunque, actualmente, parece ser mas frecuente de lo que se pensaba. La infeccion diseminada debe sospecharse en todo paciente que reciba BCG y con un cuadro clinico compatible. El conocimiento de esta complicacion y la instauracion precoz del tratamiento especifico son la unica medida que mejorara el pronostico de esta importante complicacion.

Los pacientes con sindrome de apneas-hipopneas durante el sueno tienen una mayor probabilidad de presentar mas complicaciones postoperatorias. La utilizacion precoz de tratamiento con presion positiva continua de la via aerea puede evitar su aparicion. Se presenta el caso de un paciente intervenido de obesidad morbida que desarrollo, en el postoperatorio inmediato, un cuadro de insuficiencia respiratoria aguda, que preciso el reingreso en la unidad de reanimacion y evoluciono favorablemente tras la instauracion de tratamiento con presion positiva con 2 niveles de presion. Posteriormente se confirmo que presentaba sindrome de apneas-hipopneas durante el sueno.

Se estudian 338 pacientes con sindrome toxico epidemico desde el inicio de la enfermedad hasta el noveno mes de evolucion. Parace que la evolucion de la enfermedad ha sido independiente de la gravedad del cuadro inicial y del tratamiento esteroideo recibido en los primeros dias. En el momento evolutivo en el que se cierra el presente trabajo, los parametros mas relevantes son la afectacion neuromuscular con la consiguiente restriccion y la persistencia de los trastornos DLCO. Este ultimo parametro parece estar en relacion con la HAP.

Se revisa la historia clinica de 96 pacientes diagnosticados de carcinoma broncogenico con objeto de analizar la rentabilidad de la tomografia axial cerebral en el «estadiaje» inicial del carcinoma broncogenico. La incidencia de metastasis cerebrales fue elevada (22%). Un 8% de los pacientes neurologicamente asintomaticos presentaron metastasis cerebrales silentes. Se hace referencia a la falta de unanimidad existente en la literatura con respecto a su utilizacion sistematica en el «estadiaje» del carcinoma pulmonar. Se concluye, por parte de los autores, en la rentabilidad de su empleo en todos aquellos pacientes portadores de un carcinoma broncogenico en estadio operable o que esten diagnosticados de un carcinoma de celulas pequenas.

Se presenta un caso de artritis reumatoide asociada a enfermedad pulmonar obstructiva con caracteristicas propias y diferentes a las descripciones clasicas de bronconeumopatias en el curso de la artritis reumatoide. Tal entidad debe tenerse en cuenta en el diagnostico diferencial de las complicaciones broncopulmonares de estos pacientes.