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Vol. 45. Issue S1.
Pages 3-10 (February 2009)
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Vol. 45. Issue S1.
Pages 3-10 (February 2009)
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Novedades en la epidemiología, la historia natural, el diagnóstico y el tratamiento del síndrome de apneas-hipopneas durante el sueño
Innovations in the Epidemiology, Natural History, Diagnosis and Treatment of Sleep Apnea-Hypopnea Syndrome
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Concepción Hernándeza,
Corresponding author
CONCEPCION.HERN@telefonica.net

Autor para correspondencia.
, Joaquín Durán-Cantollab, Patricia Lloberesc, Mónica Gonzálezd
a Servicio de Neumología, Hospital Universitario de Canarias, La Laguna, Tenerife, España
b Unidad Respiratoria de Trastornos del Sueño, Hospital Txagorritxu, Vitoria, Álava, España
c Servicio de Neumología, Hospital Vall d’Hebron, Barcelona, España
d Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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En la siguiente revisión se sintetizan los artículos más relevantes publicados en relación con el síndrome de apneas-hipopneas durante el sueño (SAHS) durante el presente año. El análisis de los múltiples factores que participan en el riesgo de enfermedad cardiovascular asociada al SAHS ocupa en la actualidad gran parte del interés de la comunidad científica. En este sentido, son numerosos los estudios que ponen de manifiesto el papel de los mediadores inflamatorios e inmunológicos, su relación con el daño endotelial y su influencia en la génesis de enfermedad cardiovascular en pacientes con SAHS. El papel de la CPAP en evitar este riesgo cardiovascular ha tenido resultados diversos. Si bien en la insuficiencia cardíaca no existen evidencias sobre el beneficio o perjuicio de su uso, en el accidente cerebrovascular se ha confirmado el SAHS como factor predisponente y el aumento de mortalidad constatado justificaría el intento de tratar el SAHS en estos pacientes. De igual modo, la reducción de las cifras de presión arterial encontradas en sujetos en tratamiento con CPAP reduciría el riesgo de enfermedad cardiocerebrovascular. Los conocimientos recientes que demuestran la expresión plurifenotípica del SAHS permiten vislumbrar un futuro de enfermedad basado en diferentes fenotipos específicos, donde la tradicional sintomatología que definía el síndrome no limite su tratamiento. Conseguir un método diagnóstico fiable y coste-efectivo, que responda a las demandas del problema de salud pública que representa el SAHS, especialmente en sectores de la población que permanecen más infradiagnosticados y menos conocidos, como los niños, las mujeres y la pobla ción anciana, es otro de los retos que se refleja en los estudios publicados. En resumen, los crecientes conocimientos sobre la biología del SAHS, sus implicaciones cardiovasculares y su repercusión en la morbimortalidad de la población nos permitirán en los próximos años comprender la verdadera dimensión de esta enfermedad.

Palabras clave:
Síndrome de apneas-hiponeas durante el
sueño (SAHS)
CPAP
Riesgo cardiovascular
Métodos diagnósticos
Mediadores inflamatorios
Abstract

The following review summarises the most important articles published on sleep apnea-hypopnea syndrome (SAHS) during the current year. The analysis of the many factors implicated in the risk of cardiovascular diseases associated with SAHS is currently of great interest to the scientific community. There are many studies on this subject that demonstrate the role of inflammatory and immunological mediators, their relationship with endothelial damage and their influence in the genesis of cardiovascular disease in patients with SAHS. The role of CPAP in preventing this cardiovascular risk has had varied results. Although there is no evidence of benefit or harm in its use in heart failure, in cerebrovascular accidents SAHS has been confirmed as a predisposing factor and the reported increase in mortality would justify the intention to treat SAHS in these patients. Likewise, the reduction in blood pressure found with CPAP treatment could reduce the risk of cardio-cerebrovascular disease. The recent knowledge that there is expression of multiple phenotypes of SAHS gives a glimpse in the future of a disease based on different specific phenotypes, where the traditional symptomatology that defined the syndrome does not limit its treatment. To obtain a reliable and cost-effective diagnostic method that responds to the demands of the public health problem that is SAHS, particularly in sectors of the population that remain under-diagnosed and less well known, such as children, women and the elderly population is another one of the challenges reflected in published studies. In short, the growing knowledge on the biology of SAHS, its cardiovascular implications and its effect on the morbidity and mortality of the population will enable us to understand the true dimension of this disease in the next few years.

Keywords:
Sleep apnea-hypopnea syndrome (SAHS)
CPAP
Cardiovascular risk
Diagnostic methods
Inflammatory mediators
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Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
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