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Sleep is considered an essential part of life and plays a vital role in good health and well-being. Equally important as a balanced diet and adequate exercise, quality and quantity of sleep are essential for maintaining good health and quality of life. Sleep-disordered breathing is one of the most prevalent conditions that compromises the quality and duration of sleep, with obstructive sleep apnea (OSA) being the most prevalent disorder among these conditions. OSA is a chronic and highly prevalent disease that is considered to be a true public health problem. OSA has been associated with increased cardiovascular, neurocognitive, metabolic and overall mortality risks, and its management is a challenge facing the health care system. To establish the main future lines of research in sleep respiratory medicine, the Spanish Sleep Network (SSN) promoted the 1st World Café experts' meeting. The overall vision was established by consensus as "Sleep as promoter of health and the social impact of sleep disturbances". Under this leitmotiv and given that OSA is the most prevalent sleep disorder, five research lines were established to develop a new comprehensive approach for OSA management: (1) an integrated network for the comprehensive management of OSA; (2) the biological impact of OSA on comorbidities with high mortality, namely, cardiovascular and metabolic diseases, neurocognitive diseases and cancer; (3) Big Data Analysis for the identification of OSA phenotypes; (4) personalized medicine in OSA; and (5) OSA in children: current needs and future perspectives.

To evaluate the differences in reliability and costs of home respiratory polygraphy (HRP) when installed by the patient and by a nurse, in order to determine the factors affecting and to consider the possible generalization of self-setup procedure. Several HRP devices have been validated for obstructive sleep apnea (OSA) diagnosis but convenience of a nurse intervention in HRP installation has been scarcely studied. This is a prospective and interventional study. About 301 participants were assigned to 2 groups: self-setup and nurse intervention. Sleep study, questionnaires, and diagnostic procedures were performed following the clinical practice in 2016. Signals were considered lost above 3 min, and success of the test was established according to guidelines. Costs were calculated according to a previous multicenter study. Both groups (self-setup and nurse intervention) resulted homogeneous in age, gender, BMI, and final diagnosis of OSA. Signal losses during the test were similar in both groups. Slightly higher percentage of unsuccessful tests were obtained in the self-setup procedure (5.3 vs 2.0%, p = 0.121). The costs were similar (107 vs 105 €) in the self-setup group as compared to the nurse setup group. The setup of HRP by either the patient or nurse had similar costs and data acquisition. Both installation procedures of HRP were similar regarding test reliability and costs. Main findings are that self-installation by the patient could be similarly reliable and economic as installation by a nurse, as far as consensus guidelines are followed. This study demonstrates that self-setup of HRP is a potentially viable option for the diagnosis of OSA.

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea–hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.

Rationale: Obesity hypoventilation syndrome (OHS) is commonly treated with noninvasive ventilation (NIV) or CPAP. NIV is more complex and costly but provides ventilatory support. To date there have been no long-term or cost trials comparing these treatment modalities. Methods: We performed a large, randomized, multicenter, open-label controlled trial in Spain to compare the long-term effectiveness of NIV and CPAP using hospitalization days/year-patient as the primary end point. We carried out a simple cost analysis including effectiveness cost during 3 year of follow-up. We included the following cost groups: visits, adjustment of NIV, tests, medication, therapies and hospital resources utilization. A sensitivity analysis was conducted according to 3 different scenarios guided by the International Gross Domestic Product. Results: In total, 215 patients with untreated OHS and severe obstructive sleep apnea (OSA) were randomized to NIV or CPAP therapy and followed at least 3 years. The effectiveness was close between arms (mean difference NIV-CPAP: -0.19, 95% CI -1.13 to 0.75). The cost per patient/year was lower in the CPAP arm (1,898.2€; SD 1939.5) than the cost in the NIV arm (2,809.3€; SD 2901.6), mean difference -911.1€ (p Conclusions: In stable patients with OHS and severe OSA, despite NIV having a slight advantage in effectiveness, CPAP could be considered the first line of treatment due to its lower cost but, a case-by-case assessment is recommended to detect patients who would benefit from a switch to NIV.

Rationale: Obesity hypoventilation syndrome (OHS) is commonly treated with CPAP or noninvasive ventilation (NIV). NIV is more complex and costly but it provides ventilatory support. To date there have been no long-term trials comparing these treatment modalities. Methods: We performed a large, multicenter, open-label controlled trial in Spain to compare the long-term effectiveness of NIV and CPAP: respiratory function, Epworth sleepness scale (ESS), other clinical symptoms, blood pressure (BP) and health related quality of life (HRQL). The analysis was performed according to the intention-to-treat principle. Results: In total, 215 patients with untreated OHS and severe obstructive sleep apnea (OSH) were randomized to NIV or CPAP therapy and followed at least 3 years. PaCO2, bicarbonate and pH improved significantly with both treatments without group differences. FEV1 and FVC improved with positive airway pressure (PAP) but without significant group differences. The 6-MWD test did not improve with either PAP modality and there were no significant group differences. ESS and other clinical symptoms like dyspnea or unrefreshing sleep improved similarly with CPAP and NIV therapy. Both systolic and diastolic BP improved significantly with PAP but without group differences. HRQL tests (SF-36 physical and mental, FOSQ and VAWS) improved with PAP without any significant group differences. Conclusions: In stable patients with OHS and severe OSA, NIV and CPAP have similar long-term effectiveness improving respiratory function, symptoms, BP and HRQL. Given that CPAP has lower complexity and cost, CPAP may be the preferred treatment modality until more studies become available.

Obese children are at increased risk for developing obstructive sleep apnea (OSA), and both of these conditions are associated with an increased risk for end-organ morbidities. Both OSA and obesity (OB) have been associated with increased risk for Alzheimer disease (AD). This study aimed to assess whether OSA and OB lead to increased plasma levels of 2 AD markers amyloid β protein 42 (Aβ42) and pre-senilin 1 (PS1).Fasting morning plasma samples from otherwise healthy children with a diagnosis of OB, OSA, or both (OSA+OB), and controls, and in a subset of children with OSA after adenotonsillectomy (TA) were assayed for Aβ42 and PS1 levels using commercial enzyme-linked immunosorbent assay kits.286 children (mean age of 7.2 ± 2.7 y) were evaluated. Compared to control subjects, OB children had similar Aβ42 (108.3 ± 31.7 pg/mL versus 83.6 ± 14.6 pg/mL) and PS1 levels (0.89 ± 0.44 ng/mL versus 0.80 ± 0.29 pg/mL). However, OSA children (Aβ42: 186.2 ± 66.7 pg/mL; P0.001; PS1: 3.42 ± 1.46 ng/mL; P0.001), and particularly OSA+OB children had significant elevations in both Aβ42 (349.4 ± 112.9 pg/mL; P0.001) and PS1 (PS1: 4.54 ± 1.16 ng/mL; P0.001) circulating concentrations. In a subset of 24 children, TA resulted in significant reductions of Aβ42 (352.0 ± 145.2 versus 151.9 ± 81.4 pg/mL; P0.0001) and PS1 (4.82 ± 1.09 versus 2.02 ± 1.18 ng/mL; P0.0001).Thus, OSA, and particularly OSA+OB, are associated with increased plasma levels of AD biomarkers, which decline upon treatment of OSA in a representative, yet not all- encompassing subset of patients, suggesting that OSA may accelerate AD-related processes even in early childhood. However, the cognitive and overall health-related implications of these findings remain to be defined.

BackgroundObesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions.AimTo examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community.MethodsObese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the two PSGs were assayed for multiple inflammatory and metabolic markers including interleukin (IL)-6, IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), adiponectin, apelin C, leptin and osteocrin.ResultsOut of 122 potential candidates, 100 obese children with OSA completed the study with only one-third exhibiting normalization of their PSG after T&A (that is, apnea-hypopnea index (AHI) ≤1/hour total sleep time). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST).ConclusionsA defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.

Background: Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea (OSA), but compliance and variables involved in CPAP adherence in women are unknown. Objectives: To analyse CPAP adherence and variables associated with CPAP compliance in women with OSA. Methods: We analysed 151 women with moderate-to-severe OSA (AHI≥15) who participated in a randomized controlled trial (NCT02047071) and received CPAP for 3 months. Good adherence was defined as an objective average use ≥ 4 hours/night. To identify independents predictors of adherence, multivariate logistic regression analyses were performed. Results: Nine women were excluded from the analyses because they did not begin CPAP, two women dropped out, and 140 were still on CPAP therapy at the end of the follow-up. The mean CPAP use was 5.09±2.05 hours/night at the end of the first month and 5.24±1.99 hours/night at the end of the follow-up. 73.9% (105/142) of the women had good CPAP adherence at the end of the first month, and 79.6% (113/142) at the end of follow-up. Independent baseline predictors of good adherence were the number of hour of sleep (OR 1.34, 95%CI: 1.01 to 1.76, p=0.038) and the use of antidepressant drugs (OR 0.27, 95%CI: 0.11 to 0.67, p=0.005). In addition, a fewer number of side-effects during the follow-up period was also a predictor of good CPAP adherence (1.8±1.4vs 2.6±1.7, p=0.010). Conclusions: In women with moderate-severe OSA, CPAP adherence at 3 months was adequate. Longer sleep duration predicted better adherence , whereas antidepressant therapy and greater number of side -effects were associated with poorer CPAP adherence.

Aim: To evaluate the succes rate of surgical treatment and residual OSAS in a cohort of children Methods: We performed an observational, longitudinal, ambispectives study in children referred to the Sleep Unit from 2000 to 2010. In all children included, we performed a clinical history, physical and otorhinolaryngology examination and Nocturnal Polysomnography (NPSG) or Nocturnal Polygraphy (NRP). Obstructive apnea/Hypopnea index (OAHI)≥3 on NPSG and respiratory disturbances index (RDI)≥4.6 on NRP were taken as diagnosis of OSAS. Results: 1139 children were estudied, 672 boys and 467 girls. The average age was 4.85±3.07 years and the average Body Mass Index (BMI) percentile was 52.84±32.39. For the diagnosis, we used NPSG in (50.1%) and NRP in (49.9%) of children included. Snoring and respiratory pauses were reported in 85.9% and 56.9%; Hyperactivity, sleepiness and irritability were reported in 25.5%, 21.8% and 9.2%. 738 (64.8%) of children were diagnosed of OSAS, with an RDI of 9.5±12.6. There were no differences in sex between the OSAS and nonOSAS groups, but there were statistically significant differences in age, weight, neck circunference and BMI. Surgical treatment was performed in 559(75.7%) of OSAS. The success rate was 73.9%; 95% CI:69.01%-78.84% with a statiscally significant improvement in all of clinical and respiratory variables. The prevalence of residual OSAS was 26.1%. In the binary logistic regression model, age BMI, high hard palate and adenotonsillar hypertrophy emerged as a significant risk factors for OSAS. Conclusions: The persistence of disease (26.1%), in spite of treatment, it makes neccessary to follow-up and perform sleep control studies. Funded by SEPAR and FIS

Introduction: The aim of our study was to assess different criteria used to introduce NIV in ALS patients, including polysomnography (PSG) values and how it can affecttheir survival. Methods: We analyzed retrospectively 40 patients from the diagnosis of the disease to the beginning of NIV and their follow-up. We collected demographic parameters, respiratory function, respiratory symptoms, arterial blood gases and polysomnographic values. Results: We included 40 patients with ALS who received a respiratory assessment to evaluate the need of NIV. The mean age of diagnosis of the disease was 63 ± 11 years. Prior to the indication of NIV, 17 PSG studies were performed. Table 1 shows the characteristics of both groups: PSG versus non PSG group. Sleep efficiency was 49.9%, with a predominance of N1 (28.8%) and N2 (45.5%), a high index of arrousals (26.4 / h) and an obstructive AHI of 19 / h. The CT90 was 43.9%. Patients with bulbar onset had a survival of only 4 months versus 17 months of patients without bulbar onset. Patients who underwent PSG had longer survival than patients without PSG. Conclusions: The performance of PSG in ALS allows the evaluation of nocturnal respiratory failure parameters (CT90, AHI, ODI) and its behavior on sleep efficiency, which can serve as early criteria for initiating NIV and therefore help increase survival in these patients.

There are no randomized controlled trials assessing the impact of noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP) on cardiac function in obesity hypoventilation syndrome (OHS). Objective: To determine the efficacy of 2 months of NIV, CPAP or lifestyle modification (control) on echocardiographic changes. Method: OHS patients (n=302) were sequentially randomized by: 1) severe obstructive sleep apnea (OSA), into NIV, CPAP or control; 2) non-severe OSA, into NIV or control. ABG, spirometry, six-minute walk distance, Epworth sleepiness scale, polysomnography and transthoracic echocardiogram were evaluated. Results: We analyzed 2 groups: 1) with or without severe OSA and NIV or control treatments (entire OHS group; n=222); 2) with severe OSA and NIV, CPAP or control treatments (severe OSA subgroup; n=221). In the entire OHS group, NIV improved the left ventricular (LV) hypertrophy (mass index: -6.6 g/m2; 95%CI -11/-2.1 vs 3.6; 95%CI -1.1/8.3; adjusted p Conclusion: Medium-term NIV therapy is more effective than CPAP and lifestyle modification in improving PAP and LV hypertrophy in OHS

Study Objectives Nucleosomes and cell-free double-stranded DNA (dsDNA) have been suggested as promising biomarkers in cell death-related diseases, such as acute coronary syndrome (ACS). Currently, the impact of obstructive sleep apnea (OSA) in patients with ACS is unclear. Our aim was to evaluate the relationship between OSA, dsDNA, and nucleosomes and to assess their potential implication in the development of ACS. Methods Up to 549 patients were included in the study and divided into four groups (145 ACS; 290 ACS + OSA; 62 OSA; 52 controls). All patients underwent a sleep study, and serum concentrations of dsDNA and nucleosomes were measured. Results Nucleosome and dsDNA levels were higher in patients with OSA than in controls (nucleosomes: 1.47 ± 0.88 arbitary units [AU] vs. 1.00 ± 0.33 AU; p < .001, dsDNA: 315.6 ± 78.0 ng/mL vs. 282.6 ± 55.4 ng/mL; p = .007). In addition, both biomarker levels were higher in patients with ACS than in non-ACS, independently of the presence of OSA. Conclusions Both nucleosomes and dsDNA are increased in patients with OSA and might be related with the high cardiovascular risk seen in these patients. The extensive cell lysis during a myocardial infarction seems to be the major contributor to the high biomarker levels, and OSA does not seem to be implicated in such elevation when this acute event occurs. Clinical trial registration NCT01335087 (clinicaltrials.gov).

Copyright © 2017 by the American Thoracic Society, Rationale: The vast majority of children around the world undergoing adenotonsillectomy for obstructive sleep apnea-hypopnea syndrome (OSA) are not objectively diagnosed by nocturnal polysomnography because of access availability and cost issues. Automated analysis of nocturnal oximetry (nSpO2), which is readily and globally available, could potentially provide a reliable and convenient diagnostic approach for pediatric OSA. Methods: Deidentified nSpO2 recordings from a total of 4,191 children originating from 13 pediatric sleep laboratories around the world were prospectively evaluated after developing and validating an automated neural network algorithm using an initial set of single-channel nSpO2 recordings from 589 patients referred for suspected OSA. Measurements and main results: The automatically estimated apnea-hypopnea index (AHI) showed high agreement with AHI from conventional polysomnography (intraclass correlation coefficient, 0.785) when tested in 3,602 additional subjects. Further assessment on the widely used AHI cutoff points of 1, 5, and 10 events/h revealed an incremental diagnostic ability (75.2, 81.7, and 90.2% accuracy; 0.788, 0.854, and 0.913 area under the receiver operating characteristic curve, respectively). Conclusions: Neural network-based automated analyses of nSpO2 recordings provide accurate identification of OSA severity among habitually snoring children with a high pretest probability of OSA. Thus, nocturnal oximetry may enable a simple and effective diagnostic alternative to nocturnal polysomnography, leading to more timely interventions and potentially improved outcomes.

Background: Advances in information technology and telecommunications have provided the option of making it easier to diagnose and treat obstructive sleep apnea syndrome (OSAS) using telemedicine techniques. This study assessed the feasibility and reliability of respiratory polygraphy and prescription of treatment by pressure adjustment with auto-continuous positive airway pressure (CPAP) systems, both being transmitted telematically to the Sleep Unit, with teleconsultation as a support method. Subjects and Methods: Forty patients were studied from a population 80 km from the Sleep Unit using respiratory polygraphy transmitted in real time. They were divided into two groups: one was seen by conventional consultation, and the other was seen using teleconsultation. We also estimated satisfaction with this system and its costs. Results: The mean patient age was 53±10.3 years, with a body mass index of 31±6.2 kg/m2 and an Epworth score of 12±5.3. In total, 35 patients were diagnosed with OSAS, with an Apnea-Hypopnea Index of ≥10, and CPAP treatment was started in 16 of them. The agreement in the Apnea-Hypopnea Index, total apneas and hypopneas, mean oxygen saturation, and time with an oxygen saturation

Obese children are at increased risk for developing obstructive sleep apnea (OSA), and both of these conditions are associated with an increased risk for endothelial dysfunction (ED) in children, an early risk factor for atherosclerosis and cardiovascular disease. Although weight loss and treatment of OSA by adenotonsillectomy improve endothelial function, not every obese child or child with OSA develops ED. Exosomes are circulating extracellular vesicles containing functional mRNA and microRNA (miRNA) that can be delivered to other cells, such as endothelial cells.To investigate whether circulating exosomal miRNAs of children with OSA differentiate based on endothelial functional status.Obese children (body mass index z score1.65) and nonobese children were recruited and underwent polysomnographic testing (PSG), and fasting endothelial function measurements and blood draws in the morning after PSG. Plasma exosomes were isolated from all subjects. Isolated exosomes were then incubated with confluent endothelial cell monolayer cultures. Electric cell-substrate impedance sensing systems were used to determine the ability of exosomes to disrupt the intercellular barrier formed by confluent endothelial cells. In addition, immunofluorescent assessments of zonula occludens-1 tight junction protein cellular distribution were conducted to examine endothelial barrier dysfunction. miRNA and mRNA arrays were also applied to exosomes and endothelial cells, and miRNA inhibitors and mimics were transfected for mechanistic assays.Plasma exosomes isolated from either obese children or nonobese children with OSA were primarily derived from endothelial cell sources and recapitulated ED, or its absence, in naive human endothelial cells and also in vivo when injected into mice. Microarrays identified a restricted signature of exosomal miRNAs that readily distinguished ED from normal endothelial function. Among the miRNAs, expression of exosomal miRNA-630 was reduced in children with ED and normalized after therapy along with restoration of endothelial function. Conversely, transfection of exosomes from subjects without ED with an miRNA-630 inhibitor induces the ED functional phenotype. Gene target discovery experiments further revealed that miRNA-630 regulates 416 gene targets in endothelial cells that include the Nrf2, AMP kinase, and tight junction pathways.These observations elucidate a novel role of exosomal miRNA-360 as a putative key mediator of vascular function and cardiovascular disease risk in children with underlying OSA and/or obesity, and identify therapeutic targets.

Road traffic accidents are one of the main causes of death worldwide and are clearly associated with sleepiness. Individuals with undiagnosed sleep apnea-hypopnea syndrome (SAHS) are among the population with a high risk of experiencing sleepiness at the wheel and, consequently, road traffic accidents. Treatment with continuous positive airway pressure (CPAP) has been shown to reduce the risk of accidents among drivers with SAHS. For this reason, the European Union has included this disease in the psychological and physical criteria for obtaining or renewing a driving license. To comply with this European Directive, Spain has updated its driving laws accordingly. To facilitate the implementation of the new regulations, a group of experts from various medical societies and institutions has prepared these guidelines that include questionnaires to screen for SAHS, diagnostic and therapeutic criteria, and physician's report templates.

Introduction: Obesity and obstructive sleep apnea syndrome in children have been strongly and independently associated with metabolic and cardiovascular morbidities. Aim: To evaluate the presence of metabolic alterations among obese children recruited from the community. Methods: A cross-sectional, prospective multicenter study of Spanish children aged 3 – 14 years-old with a body mass index (BMI)≥ 95th percentile for age and sex were randomly selected in the first phase of this study. Four groups were obtained for follow-up:(1) No treatment; (2) Dietary intervention; (3) surgical treatment of OSA; (4) CPAP treatment of OSA. We performed fasting blood tests at baseline (T0) and ∼1-year follow-up after the intervention (T1). Results: 113 obese children with a mean age of 11.3±2.9 years completed T0 and T1 assessments within 11.8±4.1 months. Their mean BMI at T0 was 27.6±4.7 kg/m2, and mean respiratory disturbance index was 8.56±12.97 at T0 and 3.29 ± 3.99/hr TST at T1. Significant univariate associations between BMI and C reactive protein (CRP), insulin and HOMA emerged at both T0 and T1 for the whole cohort. To assess potential metabolic characteristics that independently associated with OSA incidence, OSA persistence, or residual OSA, stepwise logisitc regression models were performed, but did not reach statistical significance. However, HOMA index was a predictor of incident (OR: 1.97) and persistent OSA (OR:1.10), while CRP emerged as a predictor of residual OSA (OR:1.41). Conclusions: (1) Concurrent obesity and OSA promotes metabolic and inflammatory alterations. (2) Specific metabolic alterations appear to behave as predictors of incident, persistent and residual OSA in obese children. Funded by SEPAR.

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.

Introduction Home respiratory polygraphy (HRP) is a cost-effectiveness choice to polysomnography (PSG) for diagnosis and treatment in patients with high obstructive sleep apnea (OSA) suspicion what includes 40% of patients needing sleep study. There is not randomized control trial (RCT) focus in the same objective including the entire population needing sleep study (intermediate-high OSA suspicion). Objectives Demonstrate if HRP is a non-inferior effective and a cost-effective alternative to PSG for diagnosis and treatment in most OSA suspicion patients. Method A multicentric, non-inferiority RCT included patients with intermediate-to-high OSA suspicion from 8 centers in Spain. Patients were randomized to be managed (diagnosis and treatment decision-marking) according to PSG or HRP results for 6 months of follow-up. Sleep and quality of life questionnaires, ambulatory 24 hours blood pressure monitoring, CPAP compliance, PSG at 6 months and side effects were collected. An Epworth scale inter-group difference less than -2 in the lower bound of 1-side 95% CI was the non-inferiority premise. QALYS changes were used in a Bayesian cost-effectiveness analysis. Results 430 patients were randomized. At 6 months, changes in the Epworth scale, EuroQol, SF36, FOSQ, analogical scale, PSG and blood pressure were similar between groups. Epworth scale non-inferiority premise was -0.24 adjusted by baseline values and sites. In the cost-effectiveness plane, HRP had similar effectiveness (QALYS different -0.0043) and 421€ lower cost than PSG. Conclusion In this large RCT, HRP was a clear cost-effectiveness alternative to PSG for management of most patients with OSA suspicion. Present results can decrease costs and waiting list across countries.

Producción Científica, Study Objectives: Nocturnal oximetry has emerged as a simple, readily available, and potentially useful diagnostic tool of childhood obstructive sleep apnea-hypopnea syndrome (OSAHS). However, at-home respiratory polygraphy (HRP) remains the preferred alternative to polysomnography (PSG) in unattended settings. The aim of this study was two-fold: (1) to design and assess a novel methodology for pediatric OSAHS screening based on automated analysis of at-home oxyhemoglobin saturation (SpO2), and (2) to compare its diagnostic performance with HRP. Methods: SpO2 recordings were parameterized by means of time, frequency, and conventional oximetric measures. Logistic regression (LR) models were optimized using genetic algorithms (GAs) for 3 cutoffs for OSAHS: 1, 3, and 5 events per hour (e/h). The diagnostic performance of LR models, manual obstructive apnea-hypopnea index (OAHI) from HRP, and the conventional oxygen desaturation index ≥3% (ODI3) were assessed. Results: For a cutoff of 1 e/h, the optimal LR model significantly outperformed both conventional HRP-derived ODI3 and OAHI: 85.5% Accuracy (HRP 74.6%; ODI3 65.9%) and 0.97 AUC (HRP 0.78; ODI3 0.75) were reached. For a cutoff of 3 e/h, the LR model achieved 83.4% Accuracy (HRP 85.0%; ODI3 74.5%) and 0.96 AUC (HRP 0.93; ODI3 0.85) whereas using a cutoff of 5 e/h, oximetry reached 82.8% Accuracy (HRP 85.1%; ODI3 76.7) and 0.97 AUC (HRP 0.95; ODI3 0.84). Conclusions: Automated analysis of at-home SpO2 recordings provide accurate detection of children with high pre-test probability of OSAHS. Thus, unsupervised nocturnal oximetry may enable a simple and effective alternative to HRP and PSG in unattended settings., This research has been partially supported by the project 153/2015 of the Sociedad Española de Neumología y Cirugía Torácica (SEPAR), the project RTC-2015-3446-1 from the Ministerio de Economía y Competitividad and the European Regional Development Fund (FEDER), and the project VA037U16 from the Consejería de Educación de la Junta de Castilla y León and FEDER. L. Kheirandish-Gozal is supported by NIH grant 1R01HL130984-01. D. Álvarez was in receipt of a Juan de la Cierva grant from the Ministerio de Economía y Competitividad.

Continuous positive airway pressure (CPAP) is the treatment of choice in patients with symptomatic obstructive sleep apnea (OSA). CPAP treatment improves quality of life (QoL) in men with OSA, but its role in women has not yet been assessed.To investigate the effect of CPAP on QoL in women with moderate to severe OSA.We conducted a multicenter, open-label randomized controlled trial in 307 consecutive women diagnosed with moderate to severe OSA (apnea-hypopnea index, ≥15) in 19 Spanish sleep units. Women were randomized to receive effective CPAP therapy (n = 151) or conservative treatment (n = 156) for 3 months. The primary endpoint was the change in QoL based on the Quebec Sleep Questionnaire. Secondary endpoints included changes in daytime sleepiness, mood state, anxiety, and depression. Data were analyzed on an intention-to-treat basis with adjustment for baseline values and other relevant clinical variables.The women in the study had a mean (SD) age of 57.1 (10.1) years and a mean (SD) Epworth Sleepiness Scale score of 9.8 (4.4), and 77.5% were postmenopausal. Compared with the control group, the CPAP group achieved a significantly greater improvement in all QoL domains of the Quebec Sleep Questionnaire (adjusted treatment effect between 0.53 and 1.33; P 0.001 for all domains), daytime sleepiness (-2.92; P 0.001), mood state (-4.24; P = 0.012), anxiety (-0.89; P = 0.014), depression (-0.85; P = 0.016), and the physical component summary of the 12-item Short Form Health Survey (2.78; P = 0.003).In women with moderate or severe OSA, 3 months of CPAP therapy improved QoL, mood state, anxiety and depressive symptoms, and daytime sleepiness compared with conservative treatment. Clinical trial registered with www.clinicaltrials.gov (NCT02047071).

Study Objectives: Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome ( OHS). However, there is a paucity of data regarding its efficacy and safety. The objective of this study was to assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS. Methods: In this post hoc analysis of a previous randomized controlled trial, we studied 302 sequentially screened OHS patients who were randomly assigned to noninvasive ventilation, continuous positive airway pressure, or lifestyle modification. Outcomes at 2 mo included arterial blood gases, symptoms, quality of life, blood pressure, polysomnography, spirometry, 6-min walk distance, and hospital resource utilization. Statistical analysis comparing patients with and without oxygen therapy in the three treatment groups was performed using an intention-to-treat analysis. Results: In the noninvasive ventilation group, supplemental oxygen reduced systolic blood pressure although this could be also explained by a reduction in body weight experienced in this group. In the continuous positive airway pressure group, supplemental oxygen increased the frequency of morning confusion. In the lifestyle modification group, supplemental oxygen increased compensatory metabolic alkalosis and decreased the apnea-hypopnea index during sleep. Oxygen therapy was not associated with an increase in hospital resource utilization in any of the groups. Conclusions: After 2 mo of follow-up, chronic oxygen therapy produced marginal changes that were insufficient to consider it, globally, as beneficial or deleterious. Because supplemental oxygen therapy did not increase hospital resource utilization, we recommend prescribing oxygen therapy to patients with OHS who meet criteria with close monitoring. Long-term studies examining outcomes such as incident cardiovascular morbidity and mortality are necessary.

Background Obesity hypoventilation syndrome (OHS) is associated with a high burden of cardiovascular morbidity (CVM) and mortality. The majority of patients with OHS have concomitant OSA, but there is a paucity of data on the association between CVM and OSA severity in patients with OHS. The objective of our study was to assess the association between CVM and OSA severity in a large cohort of patients with OHS. Methods In a cross-sectional analysis, we examined the association between OSA severity based on tertiles of oxygen desaturation index (ODI) and CVM in 302 patients with OHS. Logistic regression models were constructed to quantify the independent association between OSA severity and prevalent CVM after adjusting for various important confounders. Results The prevalence of CVM decreased significantly with increasing severity of OSA based on ODI as a continuous variable or ODI tertiles. This inverse relationship between OSA severity and prevalence of CVM was seen in the highest ODI tertile and it persisted despite adjustment for multiple confounders. Chronic heart failure had the strongest negative association with the highest ODI tertile. No significant CVM risk change was observed between the first and second ODI tertiles. Patients in the highest ODI tertile were younger, predominantly male, more obese, more hypersomnolent, had worse nocturnal and daytime gas exchange, lower prevalence of hypertension, better exercise tolerance, and fewer days hospitalized than patients in the lowest ODI tertile. Conclusions In patients with OHS, the highest OSA severity phenotype was associated with reduced risk of CVM. This finding should guide the design of future clinical trials assessing the impact of interventions aimed at decreasing cardiovascular morbidity and mortality in patients with OHS. Trial Registry Clinicaltrial.gov; No.: NCT01405976 ; URL: www.clinicaltrials.gov

(1) To evaluate the effectiveness of adenotonsillectomy for the treatment of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in children. (2) To evaluate the usefulness of respiratory polygraphy (RP) for controlling post-adenotonsillectomy effects.The children studied were referred to the Burgos Sleep Unit (SU) with clinical suspicion of OSAHS before undergoing adenotonsillectomy. For all patients, a clinical history was taken and a general physical examination, as well as a specific ear, nose, and throat examination was done. RP before adenotonsillectomy, and seven months afterwards, was also done. OSAHS was diagnosed if the Apnea Hypopnea Index (AHI) was ≥ 4.6.Of the 100 children studied, 68 were male and 32 female, with an age of 4.17 ± 2.05 years. Using RP, 86 of them were diagnosed with OSAHS before undergoing adenotonsillectomy. There was a significant improvement in all clinical and polygraphic variables after adenotonsillectomy. The pre and post surgery AHI index was 11.9 ± 11.0 and 2.6 ± 1.5, respectively, with a significant mean difference (9.4 ± 10.9, p0.01). The residual OSAHS was 11.6% (CI 95%: 4.3-19%).Respiratory polygraphy is a useful tool for monitoring the effectiveness of surgical treatment and the detection of residual OSAHS in children with adenotonsillar hypertrophy.

a Unidad del Sueno, Servicio de Neumologia, Hospital Vall d’Hebron, Barcelona, Spain, (Ciberes) b Unidad Multidisciplinar de Trastornos del Sueno, Hospital Txagorritxu, Vitoria, Spain, (Ciberes) c Unidad de Neumologia, Hospital de Requena, Valencia, Spain, (Ciberes) d Servicio de Neumologia, Hospital Universitario Miguel Servet, IACS, Zaragoza, Spain, (Ciberes) e Servei de Pneumologia, Hospital del Mar-IMIM, Hospital de Sabadell, UPF, UAB, Barcelona, Spain, (Ciberes) f Servicio de Neumologia, Hospital San Pedro de Alcantara, Caceres, Spain, (Ciberes) g Servei de Pneumologia, Hospital Universitari Sagrat Cor, UB, Barcelona, Spain, (Ciberes) h Unidad de Sueno, Hospital Universitario Complejo Asistencial de Burgos, Spain, (Ciberes) i Servicio de Neumologia, Hospital Universitario Complejo Asistencial de Burgos, Spain, (Ciberes)

The present study aims to review all the major articles on respiratory sleep disorders, mechanical ventilation, and respiratory critical care published in the last year in Archivos de bronconeumologia. Between December 2009 and November 2010, 15 studies on these topics were published in Archivos de bronconeumologia. Ten of these studies dealt with respiratory sleep disorders, consisting of six original articles, one special article, one review article, one letter to the editor and one supplement on chronic obstructive pulmonary disease and its association with sleep apneas. Five articles were published on non-invasive mechanical ventilation: one editorial, one special article, one article in a supplement and two original articles. As in previous years, there was a marked difference in the number of articles published on non-invasive mechanical ventilation and sleep-apnea syndrome, with a greater number of articles being published on the latter. Although some articles highlight the importance of the place where ventilation is commenced, no study specifically dealing with intermediate care units was published in Archivos de bronconeumologia in 2010. This absence could be interpreted as a result of the low implantation of this type of unit in Spain, contrasting with the high activity undertaken in this field by pneumology services.

Resumen En el presente estudio, se analizan los trabajos publicados en Archivos de Bronconeumologia de junio de 2008 a noviembre de 2009 que hacen referencia a los trastornos del sueno, la ventilacion no invasiva y los cuidados criticos. La metodologia empleada ha sido analizar los objetivos de los trabajos presentados, con sus principales resultados y las reflexiones que han sugerido a los autores, planteandose muchas veces la posibilidad de desarrollar nuevos trabajos de investigacion. La revision incluye no solo los trabajos originales, sino tambien una reflexion acerca de las editoriales, articulos especiales y trabajos de revision.

To evaluate the reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome (SAHS) and to compare the cost of this technique with that of nighttime polysomnography performed in a sleep laboratory.This was a prospective study of a random sample of patients with clinically suspected SAHS in which the participants who underwent both home respiratory polygraphy and nighttime polysomnography were blinded as to the results of their first test. Costs were calculated based on a theoretical population of 1000 individuals. A t test for paired samples, the Pearson correlation coefficient, and a receiver operator characteristic curve were used for the statistical analysis.The study population was composed of 45 patients with a mean (SD) age of 52.3 (11) years of whom 21 (46.6%) were diagnosed with SAHS, defined by an apnea-hypopnea index greater than 10 in nighttime polysomnography. Comparison of the results obtained in both recordings revealed statistically significant correlations for all comparisons. The optimal cutoff in this population was a respiratory disturbance index of 13.7 or more, for which the area under the receiver operating characteristic curve was 87.5% (95% confidence interval, 74.2%-95.4%). The mean cost of home respiratory polygraphy in a patient with suspected SAHS was euro69, whereas that of polysomnography was euro179.Home respiratory polygraphy is a reliable technique for the diagnosis of SAHS. Using this technique routinely in patients suspected of SAHS will be more economical than using nighttime polysomnography. Uncertain results must be verified by nighttime polysomnography.

Objetivos El presente estudio se realizo con los siguientes objetivos: a) valorar la fiabilidad de la poligrafia respiratoria domiciliara (PRD) para el diagnostico de sindrome de apneas-hipopneas durante el sueno (SAHS), y b) comparar los costes derivados de la realizacion de PRD con los de la polisomnografia nocturna (PSG) efectuada en el laboratorio de sueno. Pacientes y metodos Se trata de un estudio prospectivo y ciego. La poblacion de estudio estuvo constituida por una seleccion aleatoria de pacientes con sospecha clinica de SAHS. A todo paciente incluido en el estudio se le realizaron PRD y PSG sin conocer el resultado de la primera. Para el calculo de costes se utilizo una poblacion teorica de 1.000 personas. Para el analisis estadistico se emplearon la prueba de la t de Student para muestras emparejadas, el coeficiente de correlacion de Pearson y el calculo de las curvas de eficacia diagnostica. Resultados Se estudio a 45 pacientes, con una edad media (± desviacion estandar) de 52,3 ± 11 anos, de los que se diagnostico de SAHS (indice de apneas-hipopneas ≥ 10 en la PSG) a 21 (46,6%). Al comparar los valores obtenidos en la PRD y la PSG, las correlaciones fueron significativas para todos los pares relacionados. El punto de corte optimo en nuestra poblacion fue un indice de acontecimientos respiratorios de 13,7 o mayor, con un area bajo la curva de eficacia diagnostica del 87,5% (intervalo de confianza del 95%, 74,2-95,4%). La realizacion de una PRD en un paciente con sospecha de SAHS supone un coste medio de 69 €, mientras que el de una PSG es de 179 €. Conclusiones La PRD es un metodo fiable para el diagnostico de SAHS. Su realizacion de forma protocolizada supone un ahorro respecto a la realizacion de PSG a todos los pacientes con sospecha de SAHS. Por ultimo, los resultados dudosos de la PRD requieren la realizacion de PSG.

Objetivo La demanda de consultas y estudios diagnosticos del sindrome de apneas-hipopneas durante el sueno (SAHS) se ha incrementado, lo que ha llevado a importantes demoras. Por tanto, es precisa una evaluacion actualizada de la situacion del diagnostico que sirva como herramienta de gestion a especialistas y las administraciones sanitarias que tienen la responsabilidad de solventar el problema. El objetivo del presente estudio ha sido realizar un analisis descriptivo de la situacion del diagnostico del SAHS en los hospitales espanoles. Metodos Se ha realizado un estudio descriptivo, observacional y transversal. Se establecio contacto con los centros publicos y privados incluidos en el catalogo de instituciones sanitarias del Ministerio de Sanidad de 2005. Se incluyeron aquellos que evaluaban habitualmente a pacientes con SAHS. El responsable de cada centro relleno un cuestionario sobre disponibilidad de recursos y demoras para el diagnostico. Resultados De los 741 centros con los que se establecio contacto, 217 evaluaban habitualmente a pacientes con SAHS. El 88% disponia de poligrafia respiratoria (PR) (n = 168) o polisomnografia (PSG) (n = 97). La demora media en consulta fue de 61 dias, y la demora media para realizar PR, de 224 dias. La media de equipos de PR fue de 0,99/100.000 habitantes, cuando lo recomendable es 3/100.000. La demora media para PSG fue de 166 dias. La media de camas de PSG fue de 0,49/100.000 habitantes y lo recomendable es 1/100.000. Conclusiones Se observa una notable deficiencia de recursos que lleva a inaceptables listas de espera. Aunque la situacion del diagnostico de SAHS ha cambiado favorablemente con respecto a estudios previos, sigue siendo mejorable y es imprescindible que las autoridades sanitarias dediquen mas recursos a este problema de salud publica.

Introduction: Laryngomalacia (LM) is one of the most frequent causes of the upper airway obstruction in children. Aims: To determine the presence of sleep-disordered breathing (SDB) in these patients and the need of non invasive ventilatory support. Methods: We studied 18 children with LM. The diagnosis of LM was confirmed by flexible laryngoscopy in all children. Polysomnography or respiratory polygraphy was performed at diagnosis and control. Results: Eleven of them (61.1%) were females and 4 (22.2%) of them were premature. The mean values for age and weight were 3.38±3.01 months and 4674±1418 grams. LM type 1 was present in 38.9%, type 2 in 33.3% and type 3 in 27.8%. Stridor was the most frequent symptom in 83.3% followed by the presence of feeding difficulties in 44.4% and apneas in 38.8%. Gastroesophageal reflux disease was confirmed by Phmetry in 55.5% of them. In the first sleep study, the mean values were: sleep efficiency 83%(±5.85), apnea-hypopnea index (AHI) 13.74±10.90, the cumulative percentage of time spent at saturation 90 ) 2.09%(±4.72), mean oxygen saturation 96%(±1.94) and heart rate 126±14.24 bpm. 16 children (88.8%) were diagnosed of SDB and 11(61.1%) of them required non invasive ventilatory support with a mean time of 9.45±5.26 months. In the control sleep study the mean values were: AHI 3.67±5.13, CT 90 0.43%(±1.64), mean oxygen saturation 96%(±1.38) and heart rate 111±15.01 bpm. Compared the first sleep study to control, we observed differences in AHI (p 90 (p=0.05) and mean heart rate (p=0.005). Conclusion: SDB are frequent in children with LM. Children with LM should be evaluated with sleep study in order to establish severity and the need of non invasive ventilatory support.

Introduction: Apparent life threatening event (ALTE), is an apnea event with an alteration of muscle tone and skin coloration, with appearance of imminent death. Aims: To analyze polysomnographic findings in patients with ALTE. Methods: A descriptive, retrospective study of 12 infants with ALTE. Medical history, blood test, brain doppler ultrasound, electroencephalogram, echocardiogram, magnetic resonance imaging, Phmetry, upper airway exploration and sleep study were performed. Results: Five of them were men and 7 women, with a mean age of 54.25 ± 36.89 days. Four were premature and 5 with underweight at born. Mean Apgar was 7.9 and 9. 33% had sudden death family history. More frequent symptoms were coloration change (75%), apnea (33.33%) and stiffness (33.33%). 25% of them presented respiratory acidosis, 33.33% showed an increase in lactic acid and 50% mild or moderate gastroesophageal reflux (GER). Sleep study were performed in all infants: 7 by Polygraphy and 5 by polysomnography. The mean values obtained were: respiratory events 157.42±255.23, apnea-hypopnea index (AHI): 17.63±33.96, Central AHI:10.84, Obstructive AHI: 6.70±11.2, respiratory disturbance index (RDI): 21.96±40.16, minimum heart rate 95.11±17.48, minimum oxygen saturation 88.18±3.28 and CO2 peak 46.50±4.45. The final diagnosis were: GER (1,33%), central sleep apnea (41.7%); obstructive sleep apnea (33.3%), and idiophatic (16.66%). Sleep-disordered breathing associated with GER were present in 60% of infants. 50% of infants received anti-reflux treatment, 33.3% caffeine, and two infants non invasive ventilation. Conclusion: Sleep-Disordered breathing are frequent in ALTE and GER is frequently associated with obstructive sleep events.

There should be a procedure for certification of sleep centres and physicians http://ow.ly/HLGm3

Hepatocyte apoptosis and macrophage activation contribute to the disease progression of nonalcoholic fatty liver disease (NAFLD). Obstructive sleep apnea (OSA) in obese children is associated with the severity of NAFLD. The aim of this study was to evaluate plasma levels of soluble Fas (sFas), soluble Fas ligand (sFasL), cytokeratin 18 (CK18) (markers of apoptosis), and soluble CD163 (sCD163) (marker of macrophage activation) in obese children with and without OSA.Consecutive obese children who were evaluated for OSA were recruited. The diagnosis of OSA was made using overnight polysomnography (PSG). Fasting blood samples were used to determine plasma CK18, sFas, sFasL, and sCD163 levels using specific sandwich enzyme-linked immunosorbent assay (ELISA).Fifty-eight subjects were included in the analysis with a mean age of 8.9 ± 3.2 years and a mean body mass index (BMI) z-score of 2.4 ± 0.49. Circulating sFas and sFasL levels were significantly lower in subjects with mild and severe OSA compared with those without OSA (p 0.005 for both). In addition, sCD163 levels increased with an increasing severity of OSA (no OSA = 1.6 ± 0.25 mg/L, mild OSA = 2.3 ± 0.45, and severe OSA = 3.0 ± 0.52; p 0.001), and they correlated with the apnea-hypopnea index (AHI) [rho (95% confidence interval, CI) of 0.71 (0.41, 1.00), p-value0.001]. In six patients with severe OSA from whom samples were taken before and after tonsillectomy, the sCD163 level decreased significantly after treatment, and there was a trend toward an increase in sFasL.Markers of apoptosis and macrophage activation are altered in obese children with OSA, indicating increased apoptotic and inflammatory pressures.

Producción Científica, The obstructive sleep apnea syndrome (OSAS) greatly affects both the health and the quality of life of chil-dren. Therefore, an early diagnosis is crucial to avoid their severe consequences. However, the standarddiagnostic test (polysomnography, PSG) is time-demanding, complex, and costly. We aim at assessinga new methodology for the pediatric OSAS diagnosis to reduce these drawbacks. Airflow (AF) and oxy-gen saturation (SpO2) at-home recordings from 50 children were automatically processed. Informationfrom the spectrum of AF was evaluated, as well as combined with 3% oxygen desaturation index (ODI3)through a logistic regression model. A bootstrap methodology was conducted to validate the results.OSAS significantly increased the spectral content of AF at two abnormal frequency bands below (BW1)and above (BW2) the normal respiratory range. These novel bands are consistent with the occurrenceof apneic events and the posterior respiratory overexertion, respectively. The spectral information fromBW1 and BW2 showed complementarity both between them and with ODI3. A logistic regression modelbuilt with 3 AF spectral features (2 from BW1 and 1 from BW2) and ODI3 achieved (mean and 95% confi-dence interval): 85.9% sensitivity [64.5–98.7]; 87.4% specificity [70.2–98.6]; 86.3% accuracy [74.9–95.4];0.947 area under the receiver-operating characteristics curve [0.826–1]; 88.4% positive predictive value[72.3–98.5]; and 85.8% negative predictive value [65.8–98.5]. The combination of the spectral informationfrom two novel AF bands with the ODI3 from SpO2is useful for the diagnosis of OSAS in children., Ministerio de Economía y Competitividad (project TEC2011-22987), Junta de Castilla y León (project VA059U13)

Los trastornos respiratorios del sueno, en particular el sindrome de apneas e hipopneas durante el sueno (SAHS), son frecuentes en la poblacion infantil (su prevalencia se ha estimado en un 1-3%) y su causa mas frecuente es la hipertrofia adenoamigdalar. Estan infradiagnosticados y se asocian a importantes complicaciones, tales como alteraciones del crecimiento, alteraciones cognitivas e incluso, en casos graves, cor pulmonale. La polisomnografia nocturna es la tecnica diagnostica de eleccion para el diagnostico del SAHS en los ninos, pero en la poblacion infantil es necesario tener en cuenta una serie de consideraciones, como la edad y el entorno adecuado. Ademas, los criterios diagnosticos del SAHS para adultos no son utiles. El tratamiento de eleccion en los ninos con SAHS es la adenoamigdalectomia, que es curativa en un 70% de los casos.

El sindrome de apneas-hipopneas durante el sueno(SAHS) consiste en la aparicion de episodios recurren-tes de limitacion al paso del aire durante el sueno,como consecuencia de una alteracion anatomico-fun-cional de la via aerea superior (VAS) que conduce a sucolapso, y causa descensos de la saturacion de oxihe-moglobina (SaO

Sleep apnea-hypopnea syndrome (SAHS) consists of recurrent episodes in which the airflow becomes limited during sleep, a consequence of anatomo-functional abnormalities of the upper airway (UA) that lead to its collapse. This leads to a reduction in oxyhemoglobin saturation (SaO2) and causes arousals from sleep. The symptoms of this syndrome include the sensation of not having been refreshed by sleep, excessive daytime sleepiness (EDS), and neuropsychiatric, respiratory and heart problems. Epidemiological studies performed in the USA and Europe have shown that SAHS is a very prevalent disorder affecting 4%-6% of men and 2%-4% of women in the general, middle-aged adult population. 1,2 This prevalence, however, increases with age. It has been shown that SAHS is associated with a deterioration in quality of life, high blood pressure, 3,4 the development of cardiovascular and cerebrovascular disease, 5 and even with traffic accidents. 6,7 SAHS is therefore associated with excess mortality. 8,9 The pathophysiology of SAHS is complex and still poorly understood. The stability of the bore of the UA depends on the action of dilatory, abductor and oropharyngeal muscles that are normally activated (in a rhythmic fashion) during inspiration. The UA collapses when, for a particular cross sectional area, the force produced by these muscles is overcome by the negative pressure generated by the inspiratory action of the diaphragm and the intercostal muscles. 10 The tissue pressure that leads to the collapse of the airway is known as the critical closing pressure (Pcrit). Normally, the Pcrit of the UA is negative, and is lower in normal subjects than in those who snore, and even lower in snorers with SAHS. An increase in the Pcrit