Background:In December 2019, coronavirus disease 2019 emerged in Wuhan city and spread rapidly throughout China and the world. Aim: To describe the clinical features, risk factors, and predictors of hospitalization in adult patients treated for acute respiratory infections associated with coronavirus SARS-CoV-2. Material and Methods: Descriptive prospective study of ambulatory and hospitalized adult patients with confirmed COVID-19 attended between April 1 and May 31, 2020. Clinical features, chronic comorbidities and demographic data were recorded, and patients were followed for two months as outpatients. Results: We assessed 1,022 adults aged 41 ± 14 years (50% men) with laboratory-confirmed COVID-19. One-third had comorbidities, specially hypertension (12.5%), hypothyroidism (6.6%), asthma (5.4%) and diabetes (4.5%). Hospital admission was required in 11%, 5.2% were admitted to critical care unit and 0.9% were connected to mechanical ventilation. Common symptoms included fatigue (55.4%), fever (52.5%), headache (68.6%), anosmia/dysgeusia (53.2%), dry cough (53.4%), dyspnea (27.4%) and diarrhea (35.5%). One third of patients reported persistence of symptoms at one-month follow-up, specially fatigue, cough and dyspnea. In the multivariate analysis, age, fever, cough, dyspnea and immunosuppression were associated with hospitalization and ICU admission. Age, male sex and moderate-severe dyspnea were associated with requirement of mechanical ventilation. The main predictors of prolonged clinical course were female sex, presence of comorbidities, history of dyspnea, cough, myalgia and abdominal pain. Conclusions: Clinical features of COVID-19 were highly unspecific. Prediction models for severity, will help medical decision making at the primary care setting.
Performance of sleep questionnaires for the diagnosis of obstructive sleep apnea syndrome Background: The diagnosis of obstructive sleep apnea syndrome (OSAS) is based on nocturnal records: polysomnography or respiratory polygraphy. However, their high costs limit their use. Aim: To examine the predictive value of three sleep questionnaires (STOP, STOP-Bang, Epworth Sleepiness Scale (ESS) in the screening of OSAS in Chilean adults. Material and Methods: During the National Health Survey 2016/17, 205 adults aged 50.7 ± 15.0 years (46% males) living in the Metropolitan Region answered sleep questionnaires and underwent an ambulatory respiratory polygraphy. The sensitivity, specificity, positive and negative predictive values and receiver operating characteristic curves of sleep questionnaires were calculated. Results: Fifty nine percent of participants had OSAS which was moderate to severe in 26%. The clinical variables associated with OSAS were age, male gender, hypertension, dyslipidemia, overweight, cervical and waist circumferences, history of regular snoring and witnessed apneas. Daytime somnolence, insomnia and unrefreshing sleep were not associated to OSAS risk. STOP, STOP-Bang and ESS questionnaires classified 64%, 71% and 12% of cases as high risk for OSAS, respectively. The STOP and STOP-Bang questionnaires had the highest sensitivity to predict OSAS (76% and 89%, respectively) while the ESS had the highest specificity (91%). Conclusions: The sleep questionnaires allowed to identify the subjects at high risk for OSAS in this sample of adults from the Metropolitan Region.
Rendimiento de los cuestionarios de sueño en la pesquisa de pacientes adultos con síndrome de apnea obstructiva del sueño según sexo FernanDo salDías PeñaFiel 1 , GerarDo salinas rossel a , JoseFina cortés meza b , Daniela Farías nesVaDba b , aleJanDro Peñaloza taPia b , carolina aGuirre marDones 2 , orlanDo Díaz Patiño 1 Gender differences in clinical features and performance of sleep questionnaires in adults with obstructive sleep apnea syndrome Background:Women with obstructive sleep apnea-hypopnea syndrome (OSAS) are less likely to be assessed or to receive an appropriate diagnosis, and they may have poorer quality of life and survival rates. Aim: To assess gender-specific clinical differences in adult patients with OSAS. Material and Methods: A standardized clinical questionnaire and four sleep questionnaires (Berlin, Epworth Sleepiness Scale, STOP and STOP-Bang) were administered and anthropometric data were measured. Patients underwent an overnight in-laboratory polysomnography to confirm the diagnosis of OSAS. Receiver operating characteristic curves, sensitivity and specificity of clinical manifestations and sleep questionnaires were calculated. Results: Of 1,464 screened patients, 509 were female, 58.6% had moderate to severe OSAS. Clinical variables associated with OSAS risk in women were age, insomnia, nocturia, hypertension and cervical circumference. Paired by age and respiratory events, the snoring frequency was similar in both genders, although witnessed apneas and high cervical circumference and waist/hip ratio were more common in males. Morning headaches, insomnia, excessive daytime sleepiness, depression, anxiety and poor quality of sleep were more common in women. Women were older than men, more obese (although with an obesity pattern less centrally distributed) and referred hypertension, diabetes, depression and hypothyroidism with higher frequency. Sleep questionnaires performance were similar in both sexes. Conclusions: It is likely that women with OSAS may partially be underdiagnosed due to circumstances related to a different OSAS clinical expression.
Accuracy of sleep questionnaires for obstructive sleep apnea syndrome screening Background: Simple but accurate tools should be used to identify patients with obstructive sleep apnea syndrome (OSAS), aiming at an early detection and prevention of serious consequences. Aim: To assess the predictive value of four sleep questionnaires (Berlin, Epworth Sleepiness Scale [ESS], STOP, and STOP-Bang) in the screening of patients with OSAS. Material and Methods: The four sleep questionnaires were administered to 1,050 snorers aged 56 ± 15 years (68% males) assessed at a sleep clinic. An overnight unattended respiratory polygraphy was performed to all patients to confirm the diagnosis of OSAS. The sensitivity, specificity, positive and negative predictive values of the four questionnaires were calculated. Results: Eighty four percent of participants had OSAS. The clinical variables associated with OSAS risk were age, male gender, hypertension, overweight, cervical circumference, waist/hip ratio, history of snoring, witnessed apneas and nycturia. Eighty-three, 86, 92 and 46 % of cases were classified as having a high risk for OSAS, according to the Berlin, STOP and STOP-Bang questionnaires and ESS, respectively. STOP and STOP-Bang questionnaires had the highest sensitivity to predict OSAS (88 and 95%, respectively) while the Flemons Index had the highest specificity (82%). Conclusions: Sleep questionnaires were able to identify patients with a high risk for OSAS but without accurately excluding those at low risk.
A surveillance system to detect COVID-19 infections in health care workers. Experience in 209 cases Background: Healthcare personnel are a high-risk group for acquiring CO-VID-19 disease. They represent 4 to 20% of the total number of cases reported in different geographical areas. Aim: To describe an epidemiological surveillance strategy to detect symptoms compatible with SARS-CoV-2 infection and early case detection among healthcare personnel at a university hospital. Patients and Methods: We assessed 209 healthcare workers reporting symptoms suggestive of COVID-19 in a telephone counseling system. After a structured evaluation, the suggestions ranged from having a SARS-CoV-2 nasopharyngeal swab PCR test, consulting in the emergency room or at outpatient clinic or returning to work. Results: In 61% of assessed workers a coronavirus SARS-CoV-2 nasopharyngeal swab PCR was requested and 28 (22%) were positive. In a multivariate analysis, the clinical variables associated with a positive PCR test were the presence of fever, sudden loss of smell or taste, and a history of contact with a COVID-19 positive case. Conclusions: The telephone symptom monitoring program allowed the early detection of a significant number of healthcare officials with acute respiratory infection due to coronavirus SARS-CoV-2, it is easy to implement and has a low cost.
Background: Identifying risk factors for lung cancer in the population could improve the cost-effectiveness of early detection programs using thoracic computed tomography (CT (Rev Med Chile 2016; 144: 1382-1390
Prevalence of obstructive sleep apnea syndrome in Chilean adults. A sub-study of the national health survey, 2016/17 Background: Obstructive sleep apnea syndrome (OSAS) affects approximately 10%-20% of adults and is associated with obesity, hypertension and metabolic syndrome. Aim: To assess the prevalence and risk factors associated with OSAS in Chilean adults. Material and Methods: A standardized sleep questionnaire and respiratory polygraphy at home were conducted on adults aged 18 years or more, residing in the Metropolitan Region and enrolled in the 2016/17 National Health Survey. Results: Two-hundred and five people between 18 and 84 years old (46% men, mean age 50 years) underwent overnight respiratory polygraphy at home. The estimated obstructive sleep apnea prevalence was 49% (62% men, 31% women) considering an apnea-hypopnea index ≥ 5 respiratory events/hour, and 16% (21% men, 13% women) considering an apnea-hypopnea index ≥ 15 respiratory events/hour. The prevalence of obstructive sleep apnea continuously increased along with age for men and women, with a later onset for women. Age, gender, body mass index, cervical and waist circumference, snoring, reporting of apnea by proxies, self-reported cardiovascular and metabolic diseases such as hypertension, diabetes and dyslipidemia, were significantly associated with OSAS. No association was found with insomnia and daytime sleepiness. Conclusions: The prevalence and risk factors associated to obstructive sleep apnea syndrome were high among these adults.
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