Efecto de la presión positiva continua en las vías aéreas y de la cirugía de las vías aéreas superiores sobre los biomarcadores en condensado de aire exhalado y en suero en pacientes con apnea del sueño

Introduction

Studies on inflammation biomarkers in serum and in exhaled breath condensate (EBC) in obstructive sleep apnea (OSA) have shown conflicting results. The objective of this study is to assess EBC and serum biomarkers in OSA patients at baseline and after continuous positive airway pressure (CPAP) or upper airway surgery (UAS).

Patients and methods

Nine OSA patients referred for UAS were matched for anthropometric characteristics and apnea-hypopnea index with 20 patients receiving CPAP. pH, nitrite (NO₂⁻), nitrate and interleukin 6 in EBC and NO₂⁻, nitrate, leukotriene B₄ and interleukin 6 in serum were determined. EBC and serum samples were collected at baseline and 3 months after CPAP or UAS.

Results

Patients’ mean body mass index was 30 (range 24.9-40) kg/m². EBC biomarker levels at baseline were within normal range and did not differ significantly after CPAP or UAS. No significant changes were observed in the serum concentration of the biomarkers determined after CPAP but the serum concentration of NO₂⁻ increased significantly at 3 months after UAS (P = .0078).

Conclusion

In mildly obese OSA patients, EBC biomarkers of inflammation or oxidative stress were normal at baseline and remained unchanged 3 months after UAS or CPAP. Although UAS was not effective in terms of reducing OSA severity, it was associated with an increase in serum NO₂⁻.     

Chronic paroxysmal hemicrania-like headaches in a child: response to a headache diary

Chronic paroxysmal hemicrania and cluster headache are both characterized by recurrent, severe, unilateral headaches accompanied by symptoms and signs of autonomic dysfunction. They are differentiated by the frequency, duration, and medication responsiveness of the headaches. Both occur in childhood, although such reports are rare. A 6-year-old boy presented with chronic paroxysmal hemicrania-like headaches. Through the use of a headache diary, his headaches were found to follow stressful events and resolved shortly after the introduction of the diary. Precipitation of chronic paroxysmal hemicrania-like headaches by stress has not been previously reported. We recommend the use of a headache diary as both an aid to diagnosis and an initial nonpharmacological therapeutic intervention for children with such headaches.     

The paroxysmal hemicrania-tic syndrome

Two cases of paroxysmal hemicrania (PH) associated with trigeminal neuralgia are reviewed. The paroxysmal hemicrania component in one patient was episodic, while it was chronic in the other. Each headache type responded completely to separate treatment, highlighting the importance of recognizing this association. We review the six other cases of chronic paroxysmal hemicrania-tic (CPH-tic) reported, and suggest that the term paroxysmal hemicrania-tic syndrome (PH-tic) be used to describe this association.     

El síndrome de apneas-hipoapneas del sueño (SAHS) grave incrementa la excreción urinaria de eritropoyetina. Efecto del tratamiento con CPAP

Introduction

Tissue hypoxia stimulates the production of erythropoietin (EPO), the main effect of which is, in turn, to stimulate erythropoiesis. Sleep apnea-hypopnea syndrome (SAHS) is an entity characterized by repeated episodes of hypoxemia during sleep.

Electrophysiological findings in Rasmussen's syndrome

Background. Rasmussen syndrome is a rare, inflammatory and probably autoimmune disease presenting with epilepsia partialis continua which is generally in the form of myoclonic jerks and involves the upper extremities with or without head involvement. We sought to demonstrate the electrophysiological features in patients with Rasmussen syndrome. Methods. We performed continuous electrophysiological recordings of involuntary movement, as well as recordings of startle responses and long latency reflex in three patients with a diagnosis of Rasmussen syndrome. Results. Positive and negative myoclonus were recorded. Startle responses were found to be suppressed. However, long latency reflexes were high in amplitude and one patient even had a C reflex. Conclusion. Stimulus‐sensitive positive and negative cortical myoclonus are typical in epilepsia partialis continua of Rasmussen syndrome and degeneration of brainstem and reticulospinal pathways may develop in Rasmussen syndrome.     

Trait- and Frequency-Dependent Dysfunctional Habituation to Trigeminal Nociceptive Stimulation in Trigeminal Autonomic Cephalalgias

We investigated whether the stimulation frequency (SF), the pain phases, and different diagnoses of trigeminal autonomic cephalalgias (TACs) may influence the habituation to pain. We studied the habituation of the nociceptive blink reflex R2 responses at different SFs (.05, .1, .2, .3, .5, and 1?Hz), in 28 episodic cluster headache (ECH) patients, 16 during and 12 outside the bout; they were compared with 16 episodic paroxysmal hemicrania (EPH) during the bout and 21 healthy subjects. We delivered 26 electrical stimuli and subdivided stimuli 2 to 26 in 5 blocks of 5 responses for each SF. Habituation values for each SF were expressed as the percentages of the mean area value of second through fifth blocks with respect to the first one. A significant lower mean percentage decrease of the R2 area across all blocks was found at .2 to 1?Hz SF during ECH, outside of the ECH, and EPH compared with healthy subjects. We showed a common frequency-dependent deficit of habituation of trigeminal nociceptive responses at higher SFs in ECH and EPH patients, independently from the disease phase. This abnormal temporal pattern of pain processing may suggest a trait-dependent dysfunction of some underlying pain-related subcortical structures, rather than a state-dependent functional abnormality due to the recurrence of the headache attacks during the active period.

Hemicrania continua: a case in which a patient experienced complete relief on melatonin

This paper reports a case of hemicrania continua in which attacks were successfully eliminated while taking melatonin 7 mg at bedtime after the patient was no longer able to tolerate indomethacin due to gastrointestinal side effects.     

Sleep apnea-hypopnea syndromes and heart failure

Heart failure (HF) and sleep-disordered breathing are conditions highly prevalent in the general population that often co-exist in the same patient. Epidemiological and pathophysiological studies indicate that there may be a causal link between sleep-disordered breathing and HF with either left ventricular systolic dysfunction or preserved ejection fraction. The presence of sleep-disordered breathing in HF patients expose the cardiovascular system to intermittent hypoxia, sympathetic activation, and increased preload and afterload and they trigger several inflammatory, oxidative and neurohumoral mechanisms that may precipitate the progression of the disease. Although there are no available data to indicate that treating sleep-disordered breathing in HF patients reduce cardiac mortality, several studies demonstrate a significant improvement in structural and functional cardiovascular parameters. This review focuses on the clinical and epidemiological bases, the pathophysiological mechanisms and the therapeutic implications between HF and sleep apnea-hypopnea syndromes.