Original papers

Positive pressure therapy in patients with cardiac arrhythmias and obstructive sleep apnea

Background. Positive pressure therapy (CPAP) in patients with cardiac arrhythmias and obstructive sleep apnea (OSAS) may have favorable effects by correcting intermittent hypoxemia and sympathetic activation.
Objective. To assess the effect of CPAP added to pharmacological treatment in the rate control and prevention of arrhythmias recurrence in patients with OSA.
Materials and methods. Prospective, interventional study study which included patients diagnosed with OSAS (cardiorespiratory polygraphy, AHI>5/hour), and arrhythmias (ECG, Holter ECG), divided in two groups: group A (pharmacological therapy only) and group B (pharmacological therapy and CPAP). The patients were evaluated at enrollment (T0), at 3 and 6 months (T3 and T6) regarding the type, severity and recurrence of cardiac arrhythmias.
Results. 36 patients (31 men), mean age: 63.2 ± 12 years were enroled. In group A: 7 patients with ventricular extrasystoles, 8 with permanent atrial fibrillation, 1 patient with atrial flutter and 2 patients with paroxystic supraventricular tachycardia. In group B: 8 patients with ventricular extrasystoles, 5 with permanent atrial fibrillation, 2 patients with recurrent episodes of atrial fibrillation and 3 with paroxystic supraventricular tachycardia. A positive correlation (r: 0.74, p <0.001) between Oxygen Desaturation Index and AHI was found. At T6, 12 patients from group B, and 18 from group A were evaluated. In group B, the mean heart rate in patients with atrial fibrillation was 69/min., lower than in group A (82/min.), no cases with recurrent atrial fibrillation were found, and more patients with class II Lown ventricular extrasystoles passed in class I Lown, compared to group A. In group B, heart rate statistically correlated with AHI (r: 0.53, p <0.005).
Conclusion. In patients with OSAS, adding CPAP to pharmacological therapy has favorable effects on preventing recurrences, heart rate control in patients with atrial fibrillation and in reducing frequency and/or severity of ventricular extrasystoles.
Keywords: cardiac arrhythmias, obstructive sleep apnea, CPAP therapy

“Inspirom” – overview of the relationship between pulmonologist and COPD patient in Romania

The aim of the study was to provide an insight of the investigation related to multiple clinical and care problems encountered by COPD patients in relations with the practitioner.
In a 6 month prospective observational study (sponsored by Servier Pharmaceutical Company), started in 2012 and completed in 2013, in out-patient settings, we involved 39 doctors (from different pneumology centers of the country) and assessed the involvement of both doctors and 1,131 patients in their observance of the therapeutic indications, as well as patients' compliance with the medical instructions, 2 months after the therapeutic indication. In this observational study we analyzed through the new GOLD classification the COPD patients at the time of recruitment until the next monitoring visit in two months. We applied for the first time this new GOLD classification for Romanian COPD patients as an overview in a period of follow-up. Results showed that at detection time, 56% patients had mild and moderate obstruction (stage 1-2 GOLD) and 44% patients are in old GOLD stage 3-4. When we used new GOLD classification, 46.4% patients are in GOLD C and D stages, with 35% having CAT over 20 and 25% an mMRC over 2. There findings can be alarm signals related to the large number of smokers, the lack of involvement of doctors in fighting tobacco consumption, and over-assessment of mild stages of the disease. All these elements can guide future prevention programs and actions of active screening for this disease.
Keywords: COPD, GOLD, Compliance, mMRC