RESUMEN
The sensitivity of a simplified variant of forced oscillation technique (FOT) was studied for assessment of dynamic upper airway obstruction during nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnoea (OSA). The airway impedance P[FOT] was measured by FOT and the oesophageal pressure (P(oes)) was recorded during stable stage II sleep in 11 patients with OSA. The CPAP level was initially set high enough to completely abolish upper airway obstruction. To induce gradually increasing upper airway re-obstruction, the CPAP pressure was then lowered stepwise. Thirty six such manoeuvres were analysed, blind, to define the first inspiration at which upper airway re-obstruction was detectable by analysis of P[FOT](t(FOT)) and by P(oes)(t(oes)), respectively. On seven occasions t(FOT) and t(oes) occurred together, in the remaining 29 cases t(FOT) preceded t(oes) with a mean latency of 6.0+/-7.7 (0-32) breath cycles. In no case did t(oes) preceed t(FOT). FOT is a highly sensitive tool for the assessment of incipient upper airway obstruction during nCPAP therapy.
Asunto(s)
Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Oscilometría/métodos , Respiración con Presión Positiva , Síndromes de la Apnea del Sueño/complicaciones , Síndromes de la Apnea del Sueño/terapia , Anciano , Obstrucción de las Vías Aéreas/fisiopatología , Esófago/fisiopatología , Humanos , Persona de Mediana Edad , Nariz , Presión , Tiempo de Reacción , Sensibilidad y Especificidad , Método Simple Ciego , Síndromes de la Apnea del Sueño/fisiopatologíaRESUMEN
The forced oscillation technique (FOT) has been demonstrated to be a very sensitive tool for the assessment of upper airway obstruction during nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA). The present study was designed to evaluate the therapeutic efficacy of a novel auto-CPAP device based exclusively on the FOT. Following manual CPAP titration, 18 patients with OSA (mean apnoea/hypopnoea index (AHI) 48.0+/-28.1) were allocated to conventional CPAP and auto-CPAP treatment under polysomnographic control in randomized order. The patients were asked to assess their subjective daytime sleepiness using the Epworth Sleepiness Scale (ESS). The mean AHI during auto-CPAP treatment was 3.4+/-3.4 and was comparable with that obtained during conventional CPAP treatment (4.2+/-3.6). The analysis of sleep architecture, the arousal index (6.6+/-2.1 versus 7.3+/-4.4) or the ESS (5.6+/-1.8 versus 7.3+/-4.4) did not reveal any significant differences. However, the mean CPAP pressure during auto-CPAP treatment (0.84+/-0.26 kPa) and in particular the pressure applied in the lateral body position (0.74+/-0.35 kPa), was significantly lower than that employed in conventional CPAP treatment (0.93+/-0.16 kPa, both comparisons: p<0.05). The auto-continuous positive airway pressure device proved equally as effective as conventional continuous positive airway pressure. However, the mean treatment pressure was significantly reduced, especially when patients were sleeping in the lateral position.
Asunto(s)
Oscilometría/métodos , Respiración con Presión Positiva/instrumentación , Respiración con Presión Positiva/métodos , Pruebas de Función Respiratoria , Síndromes de la Apnea del Sueño/terapia , Adulto , Anciano , Automatización , Humanos , Masculino , Persona de Mediana Edad , Presión , Sueño , Síndromes de la Apnea del Sueño/fisiopatología , Fases del SueñoRESUMEN
Patients with gastric carcinoma and serosal invasion were randomized into a "treatment" or "control" protocol after R0 resection ("prophylactic group", n = 45) or palliative resection without cytoreductive surgery in cases with localized peritoneal seeding ("therapy group", n = 19). The results of a planned interim analysis after 5 years indicate that MMC-CH therapy causes little systemic toxicity but enhances the rate of intraabdominal infections (9/33 vs. 2/31, p < 0.01) and reoperations (5/33 vs 0/31, p < 0.05). The preliminary survival analysis shows a possible prognostic effect following R0 resection after 24 months (p < 0.05) and 36 months (p < 0.07), but no benefit for the palliative procedures, which caused the withdrawal of the "therapy" study arm.