RESUMO
Introduction: Sleep-disordered breathing (SDB) and gas exchange disorders are common in patients with cystic fibrosis (CF). Currently, the impact of the disease on sleep patterns in patients living at high altitude and the relationship of these patterns to lung function are largely unknown. The aim of this study was to determine the frequency of SDB in children with CF aged 6-18 years and the relationship between SDB and lung function (FEV1). Methods: This is an analytical cross-sectional study of children aged 6-18 years diagnosed with CF. Spirometry before and after bronchodilators and polysomnography with capnography were performed. Descriptive analysis of qualitative and continuous variables was performed. Spearman's correlation coefficient was used to determine the correlation between polysomnogram and lung function (FEV1). Results: Twenty-four patients with CF were included. The mean age was 10.5 ± 3.1 years and 62.5% were male. Nine children had bronchiectasis on chest CT. The median absolute baseline FEV1 was 1,880 (1,355-2,325) ml and 98% (83%-110%) of predicted value. No significant difference in FEV1% was observed between subjects with obstructive sleep apnea (OSA) and those without OSA (P = 0.56). The prevalence of OSA was 66.7% in children younger than 13 years and 40% in children older than 13 years. The Spearman correlation coefficient between FEV1 and percentage of total sleep time with saturation less than 90% (T90) was rho -0.52 (p-value = 0.018), and between FEV1 and percentage of total sleep time with saturation less than 85% (T85) was statistically significant with rho -0.45 (p-value = 0.041). A positive correlation was observed between FEV1 and SpO2 during sleep with rho 0.53 and a statistically significant p-value (0.014). Conclusions: A high prevalence of sleep apnea was found in children with CF living at high altitude, with a negative correlation between FEV1 and T90 and T85 oxygenation indices, and a positive correlation between FEV1 and SpO2 during sleep.
RESUMO
Antecedentes: en los últimos años ha sido de interés el reconocimiento de manifestaciones clínicas con que cursan los pacientes que desarrollarán malaria severa (MS), y la población militar es susceptible de adquirir la infección con el desarrollo de complicaciones asociado al retraso en el reconocimiento de sus manifestaciones clínicas. Material y métodos: se realizó un análisis de una cohorte retrospectiva de sujetos con malaria atendidos en un hospital de referencia militar y el desarrollo de complicaciones según criterios de OMS durante observación hospitalaria en mayores de 18 años; se estudiaron variables demográficas, clínicas, al examen físico, resultados paraclínicos y de manejo, los datos fueron analizados en el programa estadístico SPSS. Resultados: se analizaron 533 registros, se encontraron diferencias al ingreso en disnea 42.2% MS vs 16.88% malaria no complicada (MNC) (p<0.001), vómito 65.6% MS vs 7% MNC (p=0.002), antecedente de malaria 30% MS vs 44% MNC (p=0,006), frecuencia respiratoria 20.62 (de: 5.2) resp/min MS vs 19.62 (5.2) lat/min MNC, glasgow <15.8% MS vs 0.4% MNC, Hb 11.06 (3,25) g/dL MS vs 13.62 (2.16) MNC (p<0,001), Hto 33.48 (8.15)% MS vs 39.70 (6.68)% MNC(p<0.001), leucocitos 7390 (5601) cel/mL MS vs 6319 (4862) cel/mL MNC (p=0.027), Bilirrubina total 6 (7.55) mg/dL MS vs 2.6 (2.55) mg/dL MNC, creatinina 1.98 (3.61) mg/dL MSvs 1.03 (0.22) mg/dL (p=0.029), glicemia 95.09 (21.96) mg/dL vs 103 (22.06) mg/dL (p=0,001), P. falciparum 45.6% MS vs 28.3% MNC (p=0.047). Conclusiones: el comportamiento de la malaria en población militar es similar a la población general, sin embargo, los antecedentes de malaria, características clínicas y de laboratorio pueden ser útiles para predicción de complicaciones, se requieren más estudios para corroborar estos hallazgos. (Acta Med Colomb 2015; 40: 202-208).
Background: in recent years the recognition of clinical manifestations that occur with patients who develop severe malaria has raised interest, and the military population is susceptible of acquiring the infection with the development of complications associated with delayed recognition of its clinical manifestations. Materials and Methods: A retrospective analysis of a cohort of patients with malaria treated at a reference military hospital and development of complications according to WHO criteria during hospital observation in patients over 18 years was conducted; demographic, clinical, physical examination, paraclinical and clinical management results variables were studied. Data were analyzed in SPSS statistical progam. Results: 533 records were analyzed; differences found at hospital admission were dyspnea42.2% in severe malaria vs.16.88% in uncomplicated malaria (p <0.001), vomiting 65.6% insevere malaria vs. 7% in uncomplicated malaria (p = 0.002), history of malaria 30% in severe malaria vs. 44% in uncomplicated malaria (p = 0.006), respiratory rate 20.62 breaths/min (5.2) in severe malaria vs. 19.62 (5.2) breaths/min in uncomplicated malaria. Glasgow <15.8% in severe malaria vs. 0.4% in uncomplicated malaria, Hgb 11.06 g/dL (3.25) in severe malaria vs. 13.62g/dL (2.16) in uncomplicated malaria (p<0,001), hematocrit 33.48 (8.15) in severe malaria vs.39.70% (6.68)% in uncomplicated malaria (p <0.001), leukocytes 7390 (5601) cells/mL in severe malaria vs. 6319 (4862) cells/mL in uncomplicated malaria (p = 0.027), total bilirubin 6 (7.55)mg/dL in severe malaria vs. 2.6 (2.55) mg/dL in uncomplicated malaria, creatinine 1.98 (3.61)mg/dL in severe malaria vs. 1.03 (0.22) mg/dL in uncomplicated malaria (p = 0.029), glucose 95.09 (21.96) mg/dL vs. 103 (22.06) mg/dL (p = 0.001), P. falciparum 45.6% in severe malaria vs. 28.3% in uncomplicated malaria (p = 0.047). Conclusions: The behavior of malaria in military population is similar to that in the general population; however, the history of malaria, clinical and laboratory features may be useful for prediction of complications; further studies are needed to confirm these findings. (Acta Med Colomb2015; 40: 202-208).