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Background: Several studies have been attempting to ascertain the risks of Sleep Apnea Syndrome (SAS) and its morbidity and mortality. Objective: The main objective was to verify whether SAS increases the risk of death; the secondary objective was to evaluate its morbidity in relation to cardiovascular disease and the number of days hospitalized. Methods: A systematic review and a meta-analysis were performed of the published literature. The research focused on studies comparing the number of deaths in patients with untreated SAS and in patients with non-SAS. Results: The meta-analysis was based on 13 articles, corresponding to a total of 13394 participants divided into two groups (non-SAS = 6631; SAS = 6763). The meta-analysis revealed a clear association of SAS with the occurrence of fatal events, where the presence of SAS corresponded to a 61% higher risk of total mortality (OR=1.61; CI: 1.43 - 1.81; p < 0.00001), while the risk of death from cardiac causes was 2.52 times higher in these patients (OR = 2.52; IC: 1.80 - 3.52; p < 0.00001). Similar results were obtained for mortality from other causes (OR = 1.68; CI: 1.08 - 2.61; p = 0.02). Resembling results were obtained in the remaining outcomes: non-fatal cardiovascular events were higher in the SAS group (OR = 2.46; IC: 1.80 - 3.36; p < 0.00001), the average number of days hospitalized was also higher in the SAS group (IV = 18.09; IC: 13.34 - 22.84; p < 0.00001). Conclusion: The results show that untreated SAS significantly increases the risk of death, cardiovascular events and the average number of days hospitalized. .

Introdução: Vários estudos têm avaliado os riscos, morbidade e mortalidade associados à síndrome da apneia do sono (SAS). Objetivo: O objetivo principal foi verificar se a SAS aumenta o risco de morte e o objetivo secundário foi avaliar a sua morbidade, no que diz respeito às doenças cardiovasculares e ao número de hospitalizações. Método: Realizou-se uma revisão sistemática e metanálise da literatura publicada. A pesquisa incluiu estudos que compararam o número de mortes em doentes com SAS não tratada e sem SAS. Resultados: A metanálise se baseou em 13 estudos, o que correspondeu a um total de 13.394 participantes (sem SAS: n = 6.631; com SAS: n = 6.763). A metanálise revelou uma clara associação da SAS com a ocorrência de eventos fatais nos vários modelos analíticos utilizados, correspondendo a presença de SAS a um risco de morte 61% superior para a mortalidade total (odds ratio [OR] : 1,61; intervalo de confiança de 95% [IC] = 1,43 - 1,81; p < 0,00001), tendo sido o risco de morte por causas cardíacas 2,52 vezes maior nestes doentes (OR = 2,52; IC: 1,80 - 3,52; p < 0,00001). Resultado semelhante foi obtido para a mortalidade por outras causas (OR = 1,68; IC = 1,08 - 2,61; p = 0,02). Para os demais desfechos, os eventos cardiovasculares não fatais foram superiores no grupo com SAS (OR = 2,46; IC = 1,80 - 3,36; p < 0,00001); o tempo médio de hospitalização foi também superior nos doentes com SAS (IV = 18,09 dias; IC = 13,34 - 22,84 dias; p < 0,00001). Resultados: A presença de SAS não tratada aumenta significativamente o risco de morte, o risco de eventos cardiovasculares e a duração média de internamentos. .

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BACKGROUND: Several studies have been attempting to ascertain the risks of Sleep Apnea Syndrome (SAS) and its morbidity and mortality. OBJECTIVE: The main objective was to verify whether SAS increases the risk of death; the secondary objective was to evaluate its morbidity in relation to cardiovascular disease and the number of days hospitalized. METHODS: A systematic review and a meta-analysis were performed of the published literature. The research focused on studies comparing the number of deaths in patients with untreated SAS and in patients with non-SAS. RESULTS: The meta-analysis was based on 13 articles, corresponding to a total of 13394 participants divided into two groups (non-SAS = 6631; SAS = 6763). The meta-analysis revealed a clear association of SAS with the occurrence of fatal events, where the presence of SAS corresponded to a 61% higher risk of total mortality (OR=1.61; CI: 1.43 - 1.81; p < 0.00001), while the risk of death from cardiac causes was 2.52 times higher in these patients (OR = 2.52; IC: 1.80 - 3.52; p < 0.00001). Similar results were obtained for mortality from other causes (OR = 1.68; CI: 1.08 - 2.61; p = 0.02). Resembling results were obtained in the remaining outcomes: non-fatal cardiovascular events were higher in the SAS group (OR = 2.46; IC: 1.80 - 3.36; p < 0.00001), the average number of days hospitalized was also higher in the SAS group (IV = 18.09; IC: 13.34 - 22.84; p < 0.00001). CONCLUSION: The results show that untreated SAS significantly increases the risk of death, cardiovascular events and the average number of days hospitalized.

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Obstructive sleep apnoea syndrome (OSAS) often coexists in patients with chronic obstructive pulmonary disease (COPD). The present prospective cohort study tested the effect of OSAS treatment with continuous positive airway pressure (CPAP) on the survival of hypoxaemic COPD patients. It was hypothesised that CPAP treatment would be associated with higher survival in patients with moderate-to-severe OSAS and hypoxaemic COPD receiving long-term oxygen therapy (LTOT). Prospective study participants attended two outpatient advanced lung disease LTOT clinics in São Paulo, Brazil, between January 1996 and July 2006. Of 603 hypoxaemic COPD patients receiving LTOT, 95 were diagnosed with moderate-to-severe OSAS. Of this OSAS group, 61 (64%) patients accepted and were adherent to CPAP treatment, and 34 did not accept or were not adherent and were considered not treated. The 5-yr survival estimate was 71% (95% confidence interval 53-83%) and 26% (12-43%) in the CPAP-treated and nontreated groups, respectively (p<0.01). After adjusting for several confounders, patients treated with CPAP showed a significantly lower risk of death (hazard ratio of death versus nontreated 0.19 (0.08-0.48)). The present study found that CPAP treatment was associated with higher survival in patients with moderate-to-severe OSAS and hypoxaemic COPD receiving LTOT.

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We investigated the relationship between sleep-disordered breathing (SDB) and Cheyne-Stokes respiration (CSR) while awake as well as mortality. Eighty-nine consecutive outpatients (29 females) with congestive heart failure (CHF; left ventricular ejection fraction, LVEF <45%) were prospectively evaluated. The presence of SDB and of CSR while awake before sleep onset was investigated by polysomnography. SDB prevalence was 81 and 56%, using apnea-hypopnea index cutoffs >5 and >15, respectively. CHF etiologies were similar according to the prevalence of SDB and sleep pattern. Males and females were similar in age, body mass index, and LVEF. Males presented more SDB (P = 0.01), higher apnea-hypopnea index (P = 0.04), more light sleep (stages 1 and 2; P < 0.05), and less deep sleep (P < 0.001) than females. During follow-up (25 +/- 10 months), 27% of the population died. Non-survivors had lower LVEF (P = 0.01), worse New York Heart Association (NYHA) functional classification (P = 0.03), and higher CSR while awake (P < 0.001) than survivors. As determined by Cox proportional model, NYHA class IV (RR = 3.95, 95%CI = 1.37-11.38, P = 0.011) and CSR while awake with a marginal significance (RR = 2.96, 95%CI = 0.94-9.33, P = 0.064) were associated with mortality. In conclusion, the prevalence of SDB and sleep pattern of patients with Chagas' disease were similar to that of patients with CHF due to other etiologies. Males presented more frequent and more severe SDB and worse sleep quality than females. The presence of CSR while awake, but not during sleep, may be associated with a poor prognosis in patients with CHF.

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We investigated the relationship between sleep-disordered breathing (SDB) and Cheyne-Stokes respiration (CSR) while awake as well as mortality. Eighty-nine consecutive outpatients (29 females) with congestive heart failure (CHF; left ventricular ejection fraction, LVEF <45 percent) were prospectively evaluated. The presence of SDB and of CSR while awake before sleep onset was investigated by polysomnography. SDB prevalence was 81 and 56 percent, using apnea-hypopnea index cutoffs >5 and >15, respectively. CHF etiologies were similar according to the prevalence of SDB and sleep pattern. Males and females were similar in age, body mass index, and LVEF. Males presented more SDB (P = 0.01), higher apnea-hypopnea index (P = 0.04), more light sleep (stages 1 and 2; P < 0.05), and less deep sleep (P < 0.001) than females. During follow-up (25 ± 10 months), 27 percent of the population died. Non-survivors had lower LVEF (P = 0.01), worse New York Heart Association (NYHA) functional classification (P = 0.03), and higher CSR while awake (P < 0.001) than survivors. As determined by Cox proportional model, NYHA class IV (RR = 3.95, 95 percentCI = 1.37-11.38, P = 0.011) and CSR while awake with a marginal significance (RR = 2.96, 95 percentCI = 0.94-9.33, P = 0.064) were associated with mortality. In conclusion, the prevalence of SDB and sleep pattern of patients with Chagas' disease were similar to that of patients with CHF due to other etiologies. Males presented more frequent and more severe SDB and worse sleep quality than females. The presence of CSR while awake, but not during sleep, may be associated with a poor prognosis in patients with CHF.

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El síndrome de Prader-Labhart-Willi (SPW) es una entidad que se asocia a trastornos respiratorios durante el sueño, lo que puede tener consecuencias fatales para la vida. Se presentan 3 pacientes con diagnóstico de SPW: 2 del sexo masculino y 1 del femenino. El diagnóstico en todos ellos fue confirmado después de los 2 años de edad. Los hallazgos clínicos más relevantes fueron: talla y peso corporal normal al nacimiento así como hipotonía muscular. En 2 pacientes la obesidad se inició después de los 2 años de edad y en el otro a los 18 meses de nacidos. La acromicria y retraso mental moderado estuvo presente en los 3 pacientes. Los resultados de los cariotipos por técnica de bandas fueron 46XY para los del sexo masculino y 46XX para la del femenino. Los 2 pacientes del sexo masculino presentaron episodios de apnea durante el sueño (Sleep Apnea Syndrome), lo que ocasionó el fallecimiento de ambos por paro respiratorio antes de los 12 años de edad. Se recomienda la vigilancia estrecha de estos pacientes, principalmente durante las infecciones respiratorias y las crisis de asma bronquial(AU)

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