Introduction Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography for the diagnosis of sleep apnoea-hypopnoea syndrome (SAHS), but stronger evidence is needed. Normally, patients transport HRP equipment from the hospital to home and back, which may create difficulties for some patients. Objectives To determine both the diagnostic efficacy and cost of HRP (with and without a transportation service moving the device and telematic transmission of data) in a large sample compared with in-hospital polysomnography. Methods Patients suspected of having SAHS were included in a multicentre study (eight hospitals). They were assigned to home and hospital protocols in random order. Receiver operating characteristic curves were constructed for manual respiratory polygraphy scoring protocol and different polysomnographic cut-off points. Diagnostic efficacies for several polysomnographic cutoff points were explored and costs for two equally effective alternatives were calculated. Results Of 366 randomised patients, 348 completed the protocol. The best receiver operating characteristic curve was obtained with a polysomnographic cut-off of the apnoea-hypopnoea index (AHI)$5. The sensitive HRP AHI cut-off point (<5) had a sensitivity of 96%, a specificity of 57% and a negative likelihood ratio (LR) of 0.07; the specific cut-off (>10) had a sensitivity of 87%, a specificity of 86% and a positive LR of 6.25. The cost of HRP was half that of polysomnography. Telematic transmission costs were similar if the patients' costs were taken in to account. Conclusion HRP is an alternative to polysomnography in patients with suspected SAHS. Telematic procedures may help patients with limited mobility and those who live a long way from the sleep centre.
The HRP-based therapeutic decision was adequate when AHI was high, but deficient in the large population of patients with mild to moderate AHI. Therefore, both selecting patients with a high suspicion and severity of SAHS and future prospective cost-effectiveness studies are necessary.
Research studies have shown the potential effects of indoor environmental quality (IEQ) on pupils’ health and academic performance. The COVID-19 pandemic has prompted renewed interest in the assessment of deficient indoor air quality (IAQ) conditions in schools and has become a priority over achieving adequate comfort conditions. Scientific studies confirm aerosols as one of the transmission routes of SARS-CoV-2 so that the possibility of airborne transmission increases in indoor environments with high occupancy, such as classrooms. As a result, international protocols and guidelines have established a requirement for educational buildings to over-ventilate with a fresh outdoor air supply. The main object of this work is to analyse the effects of the COVID-19 pandemic on thermal comfort and indoor air quality, in winter, in two classrooms of southern Spain. Thus, onsite measurements of environmental variables were conducted before and during the pandemic. Both classrooms have mechanical ventilation systems as they are within a recently built primary school (2018). Results shows a decrease of 300 ppm in CO2 weekly average values during the pandemic, when hybrid ventilation is used, and a decrease of 400 ppm when schools are naturally ventilated during all teaching hours. However, the analysis of standards shows that over 60% of hours are thermal discomfort conditions.
The results of this study suggest that OSA is a risk factor for intestinal damage, regardless of metabolic profile, and that intestinal permeability might be a possible contributor to nonalcoholic fatty liver disease in patients with OSA.
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