The assessment of functional capacity is a significant part of the preoperative evaluation of patients proposed for both thoracic and abdominal surgery. The cardiopulmonary exercise test (CPET) is the most comprehensive exercise test currently used. It provides an objective assessment of the patient's training level and an individualised risk profile for complications and guides the perioperative care. This article provides a brief description of the roles of CPET in thoracic surgery. Guidelines recommend it for perioperative assessments because of its prognostic value, its utility in the postoperative period and in pulmonary rehabilitation programmes.
The purpose of this paper is to review the association between a medical entity called the floppy eyelid syndrome (FES) and a very serious respiratory disease with repercussions on various other body organs and systems: the obstructive sleep apnea syndrome. The epidemiology, pathophysiology, and treatment of these two diseases are intertwined but still not enough recognized. Eye disorders affect a great number of patients in modern societies and the cause of their suffering is often left undiscovered, practitioners preferring a symptomatic treatment. However, the ophthalmologist should be aware of the possibility of a sleep disorder in their patients with certain pathologies, as well as sleep physicians, who should be aware of the possibility of eye problems and refer them for a checkup. Finally, a review of literature is undergone, evaluating the possibility that the treatment of one or the other disease may benefit both.
Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease, especially Heart failure (HF). Central sleep apnea (CSAS) share several pathophysiological features with obstructive sleep apnea, but each with a unique pathology and specific treatment. There are considerably fewer published patient profile reports in association with CSAS-HF. The treatment for association CSAS-HF varies and depends on the etiology of respiratory disorder and leaves considerable room for improvement for future investigations. Despite progress over the last 3 decades, HF continues to have high morbidity and mortality rates. At this time, it is also uncertain whether CSAS is a consequence of HF with reduced ejection fraction or it is in fact a risk factor for the evolution of underlying cardiac pathology. Therefore, this retrospective study highlights the interaction between CSA and HF, with particular attention to age differences, a frequent reported risk factor, in a Romanian large cohort. Were included adults > 18 years old, with sleep apnea syndrome (apnea-hypopnea index-AHI>5 per hour of sleep with at least 50% of central on polygraphy-PG and after on polysomnographic-PSGsleep study) in the presence of sleep symptoms, with known HF with preserved LVEF (>40%) in a previous internal/cardiology department. Were excluded those < 18years old, with other sleep apneas (obstructive, mixed or complex), other sleep disorders (by PSG), inadequate PSG records,or patient refusal. Anthropometric data, clinical findings, vital parameters, comorbidities, treatments and investigations (see below) were analyzed in the population and also in subgroups. The majority of this study population (12 patients) were male, older, with normal weight, symptomatic and comorbidities. As many as 90% of the patients presented severe CSAS and 77.8% associated Cheyne–Stokes respiration (CSR). The comparative analysis of the subgroups in which according to the literature the associated pathologies manifest differently showed that there have not been noted major differences or statistically significant correlation between these two groups and cardiac outcomes.Still, in the group over 65 years we found that people were more predisposed to suffer from high BP, judging by the elevated level of the systolic blood pressure value, and another relevant comorbidities were atrial fibrillation, had more apneas and hypopneas during sleep and severe CSA were the most common. Following titration, AHI, central apnea index, desaturation index decreased with clinically significant. This study appeals to the importance of sleep health, an even more important aspect for Romania, where this associations underreported and even unrecognized, and thus the general condition of patients can worsen. Further research, based on other criteria of difference, is needed as the evidence is still lacking regarding the long-term consequences of CSA and long-term impact of current strategies in HF population.
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