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Introduction: Obstructive sleep apnea (OSA) seems to be associated with an increased rate of cardiovascular events and greater mortality. The objective of this study was to assess the effect of OSA and its treatment with continuous positive airway pressure (CPAP) on cardio and cerebrovascular morbimortality. Methods: Prospective study between 1993 and 1995 in which 1050 men aged 30 to 70 years old of the general population from Vitoria-Gasteiz were included. Clinical data were collected and a respiratory poligraphy was performed at the beginning and end of the study. Kaplan-Meier and Cox regression models were used. Results: Of the 1050 subjects [median age 48.0 (17.0), BMI 25.9 (4.0), AHI 6.0 (10.0)] follow-up data were obtained in 1014 men after a median of 269,0 (10,0) months [median age 69.0 (16.4), BMI 27.5 (3.9), AHI 19.0 (18.0)]. 59,2% of them had an AHI ≥ 5/h at baseline, and up to 95,8% of them at the end of the study. At the end there had been 196 (19.3%) deaths, 57 (6.0%) episodes of cerebrovascular disease and 220 (23.0%) of cardiovascular disease. Analysis showed no significant association between cardio-cerebrovascular events and OSA detected in the baseline study (p=0,212). Mortality was significantly increased in the OSA at baseline group compared with non OSA/CPAP treated patients, both in mild [HR 1,61 (1,14-2,27), p=0,007)] and in moderate-severe [HR 1,82 (1,23-2,68), p=0,003] OSA groups. Main mortality cause was cancer (50%). Conclusion: OSA prevalence significantly increases after 20 years of follow up. Non-treated OSA is associated with greater mortality.

Introduction: Several studies have shown an association between obstructive sleep apnea (OSA) and cancer. The aim of our study was to find out the association between both pathologies after a long term followup. Material and Methods: Prospective study in which 1050 men from the general population aged 30 to 70 years old from Vitoria-Gasteiz, were included between 1993-1995 and long term followed. Clinical data were collected and a respiratory polygraphy was performed on all subjects at the beginning and end. Cancer incidence and mortality were analyzed using Kaplan-Meier and Cox regression. Results: Of the 1050 men included at baseline (median age 48.0 (17.0), BMI 25.9 (4.0), AHI 6.0 (10.0), T90 1.0 (7.0)), follow-up data were obtained after a median of 269.0 (10.0) months in 1014 subjects (median age 69.0 (16.4), BMI 27.5 (3.9), AHI 19.0 (18.0), T90 10.0 (30.0)). At baseline, 20.2% of the subjects had a moderate-severe OSA and 19.7% had a T90≥13%. During the follow-up period, CPAP was prescribed in 116 patients. At the end, there were 235 (24.3%) diagnoses of cancer and 57 deaths from cancer. Cox regression, showed that the presence of a moderate-severe OSA at baseline was not significantly associated with developing cancer [HR 1.09 (0.75-1.60), p=0.644] but a T90≥13% was significantly associated with cancer diagnosis [HR 1.99 (1.41-2.79), p Conclusions: The presence of a moderate-severe OSA is not significantly associated with the development of cancer, but nocturnal hypoxemia represents a greater risk.

Introduction: The Simplified Pulmonary Embolism Severity Index (sPESI) scale is very helpful in identifying patients with acute symptomatic pulmonary thromboembolism (PTE) and a low risk of short-term death. The aim of this study was to evaluate the usefulness of this scale in elderly patients (>80 years). Material and Methods: We included 3,085 elderly patients diagnosed with PTE between December 1, 2013 and January 31, 2019. We analyzed the clinical events (death from any cause, death from PTE, recurrences and major nonfatal bleeding) during the first 30 days of treatment in the group of patients with sPESI =1 and those with sPESI >1 Results: A total of 228 patients died (7.4%, 95% confidence interval (CI) 6.5%-8.4%) during the first 30 days of treatment. Mortality from any cause and from the PTE itself was significantly lower in the group of patients with sPESI =1 compared to the group of patients with sPESI >1 (3.7% vs. 9.6%, P Conclusions: In elderly patients with symptomatic acute PTE, those with a sPESI = 1 had a 30-day mortality lower than those with a sPESI > 1. Although mortality from PTE itself was negligible in this group, all-cause mortality was high and related to the high comorbidity of the elderly patients.

Eisenmenger’s syndrome is a severe type of congenital heart disease characterized by severe pulmonary arterial hypertension. In the cases that the pressure in pulmonary circulation exceeds the systemic pressure, there appears a right-to-left shunting of blood. Consequently, the syndrome exists hypoxemia and cyanosis. Hypercapnia is not common in these patients; however, it might coexist with hypoxemic failure if there are other restrictive pathologies associated. Meanwhile, it has been described high prevalence of sleep disorders in Down syndrome. There is no evidence about the role of noninvasive ventilation in the management of these patients. We present a 39-year-old man, suffering of Down and Eisenmenger’s syndrome with multiple cardiac decompensations and obstructive sleep apnea (OSA), who was admitted to hospital due to severe somnolence, edema, and dyspnea. We observed a hypercapnic respiratory acidosis that ameliorated with noninvasive ventilation (NIV). The patient returned home with nocturnal NIV as a new treatment, and no further admission to hospital was seen in the following two years. To our knowledge, this is the first report about the utility of NIV in Eisenmenger’s and Down syndrome patients.

HFNC may be an alternative to be used during the decannulation process in tracheotomized patients due to acute respiratory failure. Material and methods: Prospective, observational, descriptive study of a consecutive cohort. Population: Patients admitted to the pulmonology facility from the medical and surgical ICU of our hospital and who met the inclusion criteria established for this study: 1) admission to the ICU with a diagnosis of ARF or chronic exacerbated; 2) have been tracheotomized because they require prolonged orotracheal mechanical ventilation and cannot be weaned from artificial ventilation; 3) maintain a situation of clinical stability, that would allow their transfer to the ventilation unit; 4) receive mechanical ventilation by supportive tracheostomy at the time of reaching the ward. Patients with neuromuscular diseases were excluded. Decanulation protocol: transfer to fenestrated cannula with deflated balloon starting HFNC at 60 L/min and sufficient FIO2 to maintain sat> 92%. Decanulation after 48 hours with cannula in situ, occluded, without evidence of problems. The results are compared with our historical decannulation series with NIV. Results: We proceeded to the decannulation of 28 patients (5 COPD, 6 OHS, 17 postsurgical). The results are presented in Table 1, where they are compared with the results of 110 decanulated patients using NIV. The stay in ICU showed no differences, but there were differences in the stay of patients in the pulmonology ward and in the total stay in the hospital. Conclusions: HFNC is effective in patients tracheotomized by ARF without ventilatory dependence.