RT info:eu-repo/semantics/doctoralThesis
T1 Apnea obstructiva del sueño posicional. Implicaciones clínicas.
A1 Arroyo Domingo, Carmen Ainhoa
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Internal medicine
K1 POSA
K1 POSA
K1 Sleep apnea
K1 Apnea del sueño
K1 32 Ciencias Médicas
AB Positional obstructive sleep apnea (POSA) include  patients with a higher rate of respiratory events in the decubitus-supine position. There is no consensus on the diagnosis of POSA, and several criteria coexist. The main hypothesis is based on the fact that the different criteria defining POSA could affect the prevalence, clinical characteristics and management of these patients. Positional patients could present greater cardiac autonomic imbalance. The main objective is to characterize POSA patients according to the APOC classification and to analyze their differences with respect to NON-POSA patients. The specific objectives are: to determine the prevalence of POSA, examine differences among APOC categories, polysomnographic and pulse oximetric characteristics, analyze repercussions on quality of sleep, life and adherence to treatment, and investigate the influence on cardiac autonomic modulation.A prospective study  was conducted with 409 patients referred to sleep clinic of the Universitary Hospital Río Hortega (July 2016 - April 2018). Complete home unmonitored nocturnal polysomnography and simultaneous recording of pulse oximetry were performed. Somnolence, sleep quality and quality of life were studied using the Epworth, Pittsburg and EuroQoL-5D questionnaires. CPAP treatment adherence variables were obtained by telemonitoring. The influence of the main definitions on the prevalence of POSA was investigated. Positional patients were analyzed according to the new APOC criteria: POSA vs. non-POSA groups. A multiclass study was performed according to APOC categories (I, II and III). Cardiac autonomic modulation was assessed through pulse rate variability (PRV) obtained by portable pulse oximetry. Conventional cardiac indexes were calculated in time and frequency, as well as multiscale entropy. Statistical analysis was performed with SPSS Statistics 24.A total of 320 patients were analyzed (21.8% were excluded due to dropout or failure to register). Of them, 233 met APOC criteria for POSA evaluation. There was great variability in the prevalence of POSA according to the reference criterion used (19.1% to 55.4%). No significant differences were found in terms of age or sex between the POSA and non-POSA groups. Positional patients displayed lower body mass index, with the APOC I group being younger. As the APOC category increased, a gradual increase in AHI, apnea index and hypopnea index was observed. The Non-POSA group displayed more pathological oximetry values than APOC I patients. There were no differences in the Epworth scale or in the Pittsburg sleep quality index. There were no significant differences in adherence to CPAP. With respect to cardiac autonomic modulation, no significant differences were found using conventional indexes.In the nonlinear context, POSA patients displayed higher entropy (greater disorder or imbalance) at low time scales (tao <6). The largest differences were observed at the smallest time scales, with significant differences between Non-POSA patients and all APOC categories (tao = 2).The results suggest that the POSA defining criterion notably affects the prevalence of the positional phenotype of OSA. As the APOC category increases, a deterioration of clinical parameters, polysomnographic indexes and increased impairment of quality of life are observed. The PRV signal displays higher autonomic imbalance in POSA patients. Multiscale entropy is useful, unlike traditional cardiac indexes, to characterize changes in nocturnal cardiac dynamics linked to positional apneas. We conclude that POSA patients could display greater cardiac involvement, so POSA may not represent a milder disease state.
YR 2023
FD 2023
LK https://uvadoc.uva.es/handle/10324/62652
UL https://uvadoc.uva.es/handle/10324/62652
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 16-ago-2024