Outlet about Management of Sleep Apnea

CPAP treatmentThe characteristics of the patients evaluated and the main results of the sleep studies are summarized in Table 1. Thirty patients (34%) were evaluated at the Hospital Asil de Granollers, 31 patients (35%) were evaluated at the Hospital General de Vic, and 27 patients (31%) were evaluated at the Hospital de Terrassa. Three patients who were initially seen were not subsequently studied in both centers due to nonmedical reasons. They were removed from the study.

Table 2 shows the distribution of patients with respect to the final outcome (see the “My Canadian Pharmacy: Investigation of Management of Sleep Apnea” section for classification). At the NRC, the final outcomes (choice of treatment) were patient discharge from the hospital (30.7%), diagnosis of SAHS-ambulatory control (21.6%), and diagnosis of SAHS-CPAP treatment (34.1%). A full polysomnography was requested in the remaining 13.6% of cases. At the RC, the percentages were 23.9%, 33%, and 36.4%, respectively, and other sleep disorders were found in 6.7% of patients. There was a substantial concordance in the Landis classification, with an agreement of 86.99% (0.711) when the patient hospital discharge, control, and CPAP treatment were analyzed. You may conduct the treatment with remedies of My Canadian Pharmacy.

The main discordances in the choice of treatment can be summarized as follows: (1) three patients were discharged from the NRC (AHI, < 10) or received a diagnosis of mild SAHS, but CPAP was indicated at the RC (high AHI); (2) in three patients, CPAP treatment was recommended at the NRC, but with follow-up at the RC; and (3) 12 patients were in other situations with no clinical relevance, the differences being mainly due to discrepancies in AHI with mild symptoms, or no symptoms other than snoring. Finally, the NRC requested a polysomnography in 13.6% of patients, given the inconsistency between the results of the simple sleep study and the clinical features. At the RC, the following disorders were diagnosed in these patients: SAHS, five patients; upper airway resistance syndrome, two patients; other sleep disorders (ie, periodic leg movements in sleep and idiopathic somnolence), three patients; and hospital discharges, two patients.

In the sleep study evaluation, the NRC obtained an AHI of 30 in 38.6% of patients. At the RC, these percentages were 29.5%, 26.1%, and 44.3%, respectively. The concordance in the categoric AHI between NRC and RC was substantial, according to the classification of Landis and Koch, with an agreement of 83.5% ( 0.649). Taking the AHI as a continuous variable, we obtained good concordance for the Lin coefficient of 0.826 (95% confidence interval, 0.759 to 0.894; p <0.0001). In the Bland-Altman evaluation, the mean average was 4.6 (95% limits of agreement, —25.08 and 34.31) [Fig 1]. This mean difference and the 95% limits of agreement were in crescendo if we separately analyze the centiles according to the magnitude of the value observed (not shown). The CT90 yields a good Lin coefficient of 0.77 (95% confidence interval, 0.677 to 0.863; p < 0.0001). The average difference in the Bland-Altman analysis was —4.3 (95% limits of agreement, —29.27 and 20.65).

Figure 1. Bland-Altman plot. The mean average between the number of events scored by the two methodologies was 4.6 (95% limits of agreement, —25.08 and 34.31).

Table 1—General Characteristics of Patients Studied

Characteristics Values
Patients (n = 88)
Male sex, % 80.6
Age, yr 50.3 ± 11.6
BMI,t kg/m2 29.6 ± 4.2
Full-night polysomnography
Sleep efficiency, % 79.5 (70-88.6)
Arousal indexf 31.5 ± 19
Stage I, % TST 6.4 (4-10)
Stage II, % TST 57 (50-70)
Slow-wave sleep, % TST 18 (9.3-24)
REM sleep,i % TST 15.2 ± 7.8
AHI, events/h 21.5 (8-57.5)
CT90, % TST 1 (08.6)
Respiratory polygraphy
RDI, events/h 15 (4.5-48.5)
CT90, % 4(022)

Table 2—Distribution of Patients According to Final Outcome

1 2 3 4
1 15 8 1 3
2 4 13 2 0
3 0 3 27 0
4 2 5 2 3