PubMed Health⌕ Search

Biomedical subjects

S Scalvini

Publications and source records attributed to S Scalvini.

At least 19 recordsLinked to original sources
PubMed2006

A pilot study of nurse-led, home monitoring for patients with chronic respiratory failure and with mechanical ventilation assistance.

We assessed the feasibility of telemedicine for home monitoring of 45 patients with chronic respiratory failure (CRF) discharged from hospital. The patients transmitted pulsed arterial saturation (pSat) data via a telephone modem to a receiving station where a nurse was available for a teleconsultation. A respiratory physician was also available. Scheduled and ad hoc appointments were conducted. Thirty-five patients were on home mechanical ventilation, 13 with invasive and 22 with non-invasive devices. The main diagnosis was chronic obstructive pulmonary disease (COPD). The follow-up period was 176 days (SD 69). In all, 376 calls for scheduled consultations were received and 83 ad hoc consultations were requested by the patients. The actions taken were: 55 therapy modifications, 19 hospitalizations in a respiratory department for decompensated CRF, three hospitalizations in an intensive care unit (ICU), 22 requests for further investigations, 25 contacts with the general practitioner (GP), 66 demands for respiratory consultations and 10 calls for the emergency department. The mean time recorded for the 459 calls was 16 min/patient/week. In 82% of calls, a pSat recording was received successfully. The nurse time required to train the users in the operation of the pSat instrument was high (mean time 30 min). However, the results showed that home monitoring was feasible, and useful for titration of oxygen, mechanical ventilation setting and stabilization of relapses.

Chronic Disease↗
PubMed2005

Effect of home-based telecardiology on chronic heart failure: costs and outcomes.

Chronic heart failure (CHF) remains a common cause of disability. We have investigated the use of home-based telecardiology (HBT) in CHF patients. Four hundred and twenty-six patients were enrolled in the study: 230 in the HBT group and 196 in the usual-care group. HBT consisted of trans-telephonic follow-up and electrocardiogram (ECG) monitoring, followed by visits from the paramedical and medical team. A one-lead ECG recording was transmitted to a receiving station, where a nurse was available for reporting and interactive teleconsultation. The patient could call the centre when assistance was required (tele-assistance), while the team could call the patient for scheduled appointments (telemonitoring). The one-year clinical outcomes showed that there was a significant reduction in rehospitalizations in the HBT group compared with the usual-care group (24% versus 34%, respectively). There was an increase in quality of life in the HBT group (mean Minnesota Living Questionnaire scores 29 and 23.5, respectively). The total costs were lower in the HBT group (107,494 and 140,874, respectively). The results suggest that a telecardiology service can detect and prevent clinical instability, reduce rehospitalization and lower the cost of managing CHF patients.

Cardiac Output, Low↗
PubMed2005

Telecardiology: one-lead electrocardiogram monitoring and nurse triage in chronic heart failure.

We investigated a home-based intervention based on telecardiology in patients with chronic heart failure (CHF). Two hundred and thirty CHF patients, aged 59 years (SD 9), in stable condition and with optimized therapy were enrolled. The programme consisted of trans-telephonic follow-up and electrocardiogram (ECG) monitoring followed by visits from a paramedical and medical team. The patient could call the centre when required (tele-assistance), while the team could call the patient at prescheduled times (telemonitoring). During the first 12 months, there were 3767 calls (873 ad hoc and 2894 scheduled calls). There were 648 events, including 126 episodes of asymptomatic hypotension and 168 episodes which were not due to cardiological symptoms. No actions were taken by the nurse after 2417 calls (64%). A change in therapy was suggested after 418 calls, hospital admission in 62 patients, further investigations for 243 patients and a consultation with the general practitioner in 41 patients. A total of 2303 one-lead ECG recordings were received (10 per patient); 126 recordings (6%) were diagnosed as pathological in comparison with the baseline one. The one-lead ECG recording was used for titration of beta-blockers in 79 patients (mean dosage 38 mg vs 42 mg, P<0.01). Home telenursing could be an important application of telemedicine and single-lead ECG recording seems to offer additional benefit in comparison with telephone follow-up alone.

Cardiac Output, Low↗
PubMed2005

Cardiac event recording yields more diagnoses than 24-hour Holter monitoring in patients with palpitations.

Palpitation is a common symptom that sometimes results from a substantial cardiac arrhythmia. We compared the diagnostic yield of trans-telephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. In all, 310 patients were randomly assigned to receive an event recorder or 24-hour Holter monitoring. Event recorders were used for seven days or until two recordings were obtained while symptoms occurred. The main end-point was an electrocardiogram (ECG) recorded during symptoms. The patients with palpitation recorded the one-lead ECG trace and sent it to a telemedicine call centre, where a nurse responded. There were 119 symptomatic patients in the event recorder group and 74 in the Holter group. The total costs were 6019 for event recording and 9605 for Holter monitoring. The average costs were 51 per symptomatic patient detected by event recorder monitoring and 130 per symptomatic patient detected by Holter monitoring. More patients therefore received a clear diagnosis, and more quickly, when using event recording than with Holter monitoring. For this reason, event recorders are preferable to Holter monitors for patients with palpitations.

Arrhythmias, Cardiac↗
PubMed2005

Role of telecardiology in the assessment of angina in patients with recent acute coronary syndrome.

We compared two models of assistance (telecardiology versus usual care) for patients discharged after acute coronary syndrome (ACS), in the assessment of angina. Two hundred patients were randomized into two groups at discharge for ACS: Group A to telecardiology and Group B to usual care. Early hospital readmission (in the first month) occurred in 16 patients (seven in Group A and nine in Group B). Six of Group A were readmitted for a cardiac cause (non-cardiac in one). Angina was the only cardiac cause. Five of the Group B patients were readmitted for a cardiac cause (non-cardiac in four). The results of the present study emphasize that patients with ACS suffer from a definite rate of cardiac symptoms within the first month (63%). Angina occurs more frequently within the first two weeks (68% of cases). Telecardiology slightly reduces hospital readmissions (telecardiology 44% versus usual care 56%), but better identifies true angina.

Angina, Unstable↗
PubMed2002

[Telecardiology: a new way to manage the relation between hospital and primary care].

In medicine, computer-applied technology enables the performance of many diagnostic investigations with their transfer to a receiving station for referral. The use of telemedicine appears particularly promising in cardiovascular disease, because the cost/effectiveness ratio of an early, tailored intervention, in terms of life-saving and functional recovery, is demonstrated. The development of telemedicine represents an advantage for the individual patient in terms of the interaction between primary and secondary care. In addition, general practitioners can gain educationally and so be equipped to handle more advanced medical problems, thus reducing the number of hospital follow-up appointments. Economic savings for the health service are a driving force. Evidence to date is that the patient seems satisfied and the general practitioner gains competence, but the extent to which telemedicine results in reduced follow-up appointments and economic savings is not yet established. The findings of studies, even if preliminary, have important implications for the design and implementation of the telemedicine service center within the health care system. Selection of patients, significant service reorganization and provision of logistic support for the setting up and functioning of the telemedicine center will be required for it to operate efficiently. Future research in this subject needs to be more scientifically organized, in order to achieve informed decisions about the appropriate use of this technology.

Cardiovascular Diseases↗
PubMed2001

[Potential cost reductions for the National Health Service through a telecardiology service dedicated to general practice physicians].

BACKGROUND: Rising health care costs resulted in increasing pressure on the health care system and stimulated new strategies for improving the efficiency of care. A telecardiology service provides a useful support to general practitioners in the management of cardiac patients and contributes to the optimization of health care costs in terms of appropriateness of hospital admission and diagnostic testing. The aim of our study was to evaluate the reduction in the number of referrals to the Emergency Department and to cardiological evaluation resulting from the employment of a telecardiology service by general practitioners. METHODS: Eight hundred and ninety-one consecutive calls arrived to the receiving station of the telecardiology service were analyzed. One hundred and fifty general practitioners received a portable electrocardiographer (Card-Guard 7100, Rehovot, Israel) transferring, by a mobile or fixed telephone, a 12-lead ECG to a receiving station, where a cardiologist was available for reporting and for interactive teleconsultation. At the onset of the phone call, a question was asked to the general practitioner: "What would you have done without the telecardiology service?". The possible answers were: "No actions"; "Referral to the Emergency Department"; "Cardiological consultancy"; "Further investigations". Then we collected the history, risk factors, symptoms and therapy of the patients; the general practitioner sent the ECG tracing by phone. RESULTS: Eight hundred and ninety-one patients were enrolled (402 males, 489 females, mean age 59 +/- 19 years); 465 (52%) patients were symptomatic; 36.4% had no evidence of previous cardiac disease, 35.1% had systemic hypertension, 10.6% had ischemic cardiac disease, 3.7% had atrial fibrillation, and 11.9% other diseases. ECG was normal in 55%. The general practitioners would have sent to the Emergency Department 106 patients (11.9%), and requested further investigations in 717 patients (80.5%). The cardiologist of the telecardiology service solved the problems of the general practitioners in 657 cases (73.7%), sent 56 patients (6.3%) to the Emergency Department, and asked for further investigations in 178 patients (20%), with a reduction of 47% of Emergency Department admission (p < 0.001) and of 95% of further investigations (p < 0.0001) respectively. The cost analysis showed a reduction, between the two modalities, varying from Itl 22,760,000 and Itl 140,060,000 for 891 calls. CONCLUSIONS: Telemedicine is a useful tool for the support of general practitioners' daily activity, with a possible cost reduction due to increased appropriateness of hospital admission and of diagnostic testing.

Cardiology↗
PubMed2000

[Appropriateness of referral to the emergency department through a telecardiology service. "Boario Home-Care" researchers].

BACKGROUND: The use of telemedicine appears particularly promising in cardiovascular diseases; it may reduce the decisional time during an acute myocardial infarction, which is the greater part of the so-called "avoidable delay" and the inappropriate admission to the Emergency Department with the possibility of ruling out an acute pathology. The aim of our study was to show the diagnostic accuracy of a telecardiology service in the daily activity of general practitioners. METHODS: From February 1998 to February 1999, 150 general practitioners received a portable electrocardiographer (Card-Guard 7100) transferring, by a mobile or fixed telephone, a 12-lead ECG to a receiving station, where a cardiologist was available for the reporting and interactive teleconsultation. RESULTS: During 1 year 3456 calls took place. At the time of the ECG recording 44% of patients were symptomatic. Chest pain was present in 669 patients (44%), dyspnea in 21%, palpitation in 18%, dizziness in 7%, and asthenia in 13%. ECG and teleconsultation solved all the problems for 2452 patients (71%) and further diagnostic tests were requested in 862 patients (25%); 142 patients (4%) were sent to the Emergency Department. Cardiological diagnosis was confirmed in 95 patients (73%), while anxiety or gastritis were presumed in 35 patients (27%). In the group of patients (n = 3314) for whom the cardiologist solved the problem without admission to the Emergency Department, there were 5 patients who were admitted to the Emergency Department for myocardial ischemia in the following 48 hours after the teleconsultation. Telecardiology service showed versus Emergency Department admission a sensitivity of 95%, a specificity of 97.5%, and a diagnostic accuracy of 92.5%. CONCLUSIONS: These data confirm a good diagnostic value to the service and a useful support to the general practitioners' activity.

Electrocardiography↗
PubMed1999

Effects of oxygen on autonomic nervous system dysfunction in patients with chronic obstructive pulmonary disease.

Chronic hypoxaemia can play a pathological role in abnormalities of the autonomic nervous system (ANS). In patients with chronic obstructive pulmonary disease (COPD), chronic hypoxaemia is associated with increased mortality and only long-term oxygen therapy is able to improve their survival. Normoxaemic COPD patients have been shown to suffer from abnormalities in ANS function. The aims of this study were to evaluate ANS function in COPD patients with chronic hypercapnic respiratory insufficiency and to test whether oxygen supplementation could reverse any ANS dysfunction. Eleven stable COPD patients with chronic hypercapnic respiratory insufficiency underwent evaluation of ANS by analysis of variability in cardiac frequency at rest and during both vagal (controlled breathing) and sympathetic (tilting) stimuli breathing with and without oxygen supplementation. Thirteen male, healthy, nonsmoking volunteers served as controls. Evaluation of ANS in COPD patients during hypoxic conditions showed alterations both at rest and in response to vagal and sympathetic stimuli. Oxygen supply reversed hypoxaemia without significant changes in arterial carbon dioxide tension and, therefore, ANS alterations were corrected during sympathetic stimulus only. Breathing room air and oxygen, the resting low-frequency (LF) powers were 45+/-15 and 148+/-55 ms2 x Hz(-1), respectively, and controlled breathing LF were 107+/-41 and 141+/-113 ms2 x Hz(-1), respectively. In stable patients with chronic obstructive pulmonary disease with chronic respiratory insufficiency, hypoxaemia is associated with derangements in the autonomic nervous system which may be partially reversed by oxygen administration.

Aged↗
PubMed1999

Telecardiology community: a new approach to take care of cardiac patients. "Boario Home-Care" Investigators.

BACKGROUND: Cardiovascular diseases are the leading cause of morbidity and mortality in Western countries and represent, in terms of diagnostic and treatment measures, a large amount of health care expenses. A telecardiology service may offer to general practitioners, in real time, a useful diagnostic tool and the possibility of an accurate screening of patients with suspected ischemic heart disease. METHODS: From February to July 1998, in the provinces of Bergamo and Brescia (Italy), 178 general practitioners received a portable Card Guard 7100 electrocardiographer transferring, by a mobile or fixed telephone, a 12 lead ECG to a receiving station, where a cardiologist was available for the reporting and interactive teleconsultation. RESULTS: During the first 6 months a total 2800 calls took place. Due to incompleteness of requested data only 2254 traces, corresponding to 2254 subjects (mean age 63 +/- 18 years) were entered in the study. In 27% of patients (n = 609) there was a history of systemic hypertension, in 12.5% (n = 283) there was a history of coronary artery disease, and in 38% (n = 834) there was no history of cardiovascular diseases. At the time of ECG recording, 42% of patients (n = 949) were symptomatic: more common symptoms were chest pain (39%), dyspnea (23%), palpitation (19%), dizziness or faint (10%), and asthenia (9%). No action was suggested by cardiologists in 74% of cases. Of the remaining patients, 16% (n = 92) were referred to the Emergency Department, 27% (n = 158) were offered further diagnostic tests as an out patient, and 56% (n = 328) were started on medication or had their treatment changed. CONCLUSIONS: A telecardiology system provides a useful support to general practitioners in the management, in real time, of patients with cardiovascular conditions, and possibly contributes to optimization of health care costs in terms of appropriateness of hospital admissions and diagnostic tests.

Aged↗
PubMed1998

Is heart rate variability a reliable method to assess autonomic modulation in left ventricular dysfunction and heart failure? Assessment of autonomic modulation with heart rate variability.

Autonomic dysfunction seems to be involved in the progression and prognosis of congestive heart failure. Measurement of heart rate variability (HRV) provides a noninvasive method to obtain reliable and reproducible information on autonomic modulation of heart rate, but there is a difficulty in using HRV as a quantitative estimate of autonomic dysfunction in heart failure. This study was aimed at testing the hypothesis that abnormal modulation of heart rate assessed by power spectrum analysis may be present also in asymptomatic patients with left ventricular dysfunction and progress in patients with overt symptoms of congestive heart failure. HRV was measured in three groups of subjects: Group 1: 30 patients with chronic heart failure; Group 2: 21 patients with asymptomatic left ventricular dysfunction; and Group 3: 25 healthy volunteers as control group. HRV was evaluated by autoregressive spectral analysis with 600-beat ECG samples, while subjects were quietly recumbent (BSI), in conditions of controlled breathing (15 acts/min) (RSC) and passive orthostatism after tilting (80 degrees) (TLT). Patients in group 1 showed a reduction in the standard deviation of the R-R intervals (SDRR) (p<0.0003) and in the low frequency component (LF) (p<0.0001) compared to normal subjects. Low frequency component was not detectable in 11 patients of group I (p<0.0008). On RSC and TLT, group 1 failed to show any modification in the low frequency and high frequency components (HF) under any stimulation. Group 2 showed no modification at baseline evaluation, no increase in the high frequency component on RSC and in LF during TLT compared to controls (p<0.01 and p<0.0001 respectively). At baseline, group 1 had a lower SDRR (p<0.03) and LF (p<0.0001) vs. group 2, whereas during stimulation the two groups exhibited the same behaviour. In conclusion, reduced heart rate variability is specific for both asymptomatic and symptomatic post-ischemic left ventricular dysfunction. Our results suggest that frequency domain analysis of heart rate variability during a stimulation test allows a more accurate definition of the degree of autonomic control of heart rate.

Autonomic Nervous System↗
PubMed1996

Methacholine inhaled challenge: study of correlation among different indices expressing the result.

We tested measures of specific airway conductance (sGaw) and forced expiratory volume in one second (FEV1) versus transcutaneous oxygen tension (Ptc,O2) during inhaled methacholine bronchial challenge in 60 out-patients (38 males 22 females, mean age 33 +/- 13 yrs). The provocative doses of methacholine needed to produce a 35% decrease of sGaw (PD35,sGaw), a 20% fall in FEV1 (PD20,FEV1) and a 20% decrease in Ptc,O2 (PD20,O2) were simultaneously derived from the dose-response curves. Two groups were identified according to the PD20,FEV1 result ("responders" with a PD20,FEV1 < 2,000 micrograms methacholine and "nonresponders" with PD20,FEV1 > 2,000 micrograms methacholine). All three indices derived from the dose-response curves differed significantly between the groups (p < 0.00005). The relationship analysis showed a significantly better value for PD20,O2 versus PD35,sGaw (r = 0.98) than versus PD20, FEV1 (r = 0.62). We observed similar baseline levels and variations in arterial oxygen tension (Pa,O2) and Ptc,O2 during methacholine challenge (-25 and -27%, respectively) in 14 randomly studied responders. Thus, inhaled methacholine-induced hypoxaemia (PD20,O2) seems to reflect PD35,sGaw better than changes in FEV1. Our investigation supports the hypothesis that PD20,O2 could be useful in interpreting the methacholine inhaled challenge. It could be of help in clarifying the pathophysiological meaning of the concurrent hypoxaemia during this challenge, which should be further elucidated.

Adult↗
PubMed1996

Plasma hormone levels and haemodynamics in patients with chronic obstructive lung disease.

Chronic obstructive pulmonary disease (COPD) is associated with right heart failure and salt and water retention. The possible roles of haemodynamically active hormones in the early stages of COPD have not previously been described. Adrenaline, noradrenaline, renin activity, aldosterone, vasopressin, cortisol, growth hormone, prolactin and atrial natriuretic peptide (ANP) were measured during right heart catheterization in mixed venous blood and in a peripheral artery, in the supine and standing position, in two groups of patients with COPD: Group A with arterial oxygen tension (Pa,O2) < 8.0 kPa (60 mmHg) and Group B with Pa,O2 > 8.0 kPa (60 mmHg). A group of 15 control subjects was studied to obtain control hormonal measurements with a venous blood sample only. Haemodynamic and blood gas values and hormone levels were measured in the supine and standing positions to record changes in the various parameters in COPD patients, and the relationship between pulmonary haemodynamics and hormone levels. No differences were found in hormonal samples between peripheral artery and mixed venous blood. In comparison with the control group, both groups of COPD patients showed a significant reduction in cortisol (p < 0.0001) and in vasopressin (p < 0.005), and an increase in ANP (p < 0.05) and growth hormone (p < 0.05). A marked, but not significant, increase in renin activity, and aldosterone was also found. After standing the increment of adrenaline was significantly higher in COPD patients (p < 0.02). A significant inverse relationship was recorded between forced expiratory volume in one second (FEV1) and noradrenaline (p < 0.02). There is a complex hormonal response even in the early phase of chronic obstructive pulmonary disease. An increase of plasma levels of atrial natriuretic peptide appears to be the earliest neuroendocrine response in these patients.

Cardiac Catheterization↗
PubMed1995

Respiratory and haemodynamic modifications during right heart catheterization in COLD patients.

Noninvasive measurement of the systolic time intervals is a routine procedure for the determination of myocardial performance, even in subjects without clinical or electrocardiographic signs of cardiopathy. Statistically significant differences in pre-ejection period (PEP) and PEP/left ventricular ejection time (LVET) between days and between observations were demonstrated by Levi et al. A high correlation between systolic time intervals and catecholamines was recorded. The aim of the present study was to evaluate the spontaneous modifications in pulmonary and cardiac parameters during a stressful situation, such as right heart catheterization. Seventeen patients with chronic obstructive lung disease (COLD) underwent right heart catheterization. Heart rate (HR), systemic artery pressure (SAP), pulmonary artery pressure (PAP), cardiac output (Q'c), cardiac index (CI), systolic stroke volume (SV), respiratory rate (RR), minute ventilation (V'E), oxygen consumption (V'O2), carbon dioxide production (V'CO2), their ratio (RQ), arterial and venous O2 and CO2, systolic time intervals (total electromechanical interval (QS2), LVET, PEP, PEP/LVET), total pulmonary resistance (TPR), adrenaline (A), and noradrenaline (NA) were recorded at the beginning of the test and 20, 40, 60 and 80 min thereafter. Analysis of variance (ANOVA) showed significant differences between the observations for systolic pulmonary artery pressure (SPAP), Q'c, V'O2, V'CO2, V'E, PEP/LVET, and NA. In conclusion, it is necessary to take into account spontaneous modifications in pulmonary haemodynamic parameters following a stressful situation, such as a catheterization, when studying the effects of drugs such as vasodilators and vasoactive agents.

Cardiac Catheterization↗
PubMed1994

Decreased heart rate variability in patients with chronic obstructive pulmonary disease.

To evaluate possible autonomic nervous system (ANS) dysfunction in patients with chronic obstructive pulmonary disease (COPD) in the absence of any hypoxic neuronal damage, we studied 31 patients with COPD patients aged 31 to 68 years (55 +/- 10) and 32 age-matched healthy subjects (control). Respiratory function in the patients was as follows: FEV1 = 52 +/- 8 percent; PaO2 = 71 +/- 14 mm Hg; and PaCO2 = 40 +/- 10 mm Hg. The ANS was assessed by heart rate variability (HRV) in the time domain (SD of mean RR interval) and frequency domain (autoregressive spectral analysis recognizing low [LF] and high [HF] frequency components, vagal and sympathetic related, respectively). Patients and controls were evaluated at rest and during vagal (controlled breathing [CB]) and sympathetic (passive head-up tilt) maneuvers. Patients with COPD showed a depressed global HRV (rest SD = 34 +/- 20 ms vs 45 +/- 15 ms, p < 0.05; tilt SD = 28 +/- 14 ms vs 38 +/- 13, p < 0.01) with a predominant respiratory drive (rest HF = 44 +/- 28 vs 28 +/- 18, p < 0.05; tilt HF 42 +/- 28 vs 16 +/- 12, p < 0.01) as compared with normal subjects. In the control group, vagal and sympathetic responses were in opposite directions following a stimulus, whereas there was no significant HRV response in the COPD group. We conclude that patients with COPD have abnormalities of ANS function, with in particular a depressed HRV response to sympathetic and vagal stimuli.

Adult↗
PubMed1994

Hygroscopic condenser humidifiers in chronically tracheostomized patients who breathe spontaneously.

The aim of this study was to test the usefulness of hygroscopic condenser humidifiers on secretion and on inspired gas temperature in tracheostomized patients. Forty spontaneously breathing chronically tracheostomized patients were divided into two groups: Group 1 received a hygroscopic condenser humidifier connected to the tracheostomy, 24 h daily for 10 days; Group 2, without any protection system, was chosen as the control group. The daily number of tracheal suctions, quantity of aspirate and thickness and colouring of secretions was evaluated. At baseline, and at days 5 and 10, patients were submitted to blood gas analysis, respiratory function tests and sputum analysis. The temperature of gases breathed was measured at rest and during a hyperventilation test, with and without the hygroscopic condenser humidifier. Statistically significant differences were found in thickness and colouring of secretions between the two groups during the period of 10 days. Group 2 showed a significantly greater trend in number of bacteria than Group 1. The group with the hygroscopic condenser humidifier showed respiratory function improvement over time for forced expiratory volume in one second (FEV1) and tidal volume (VT), maximal inspiratory pressure (MIP), and maximal voluntary ventilation (MVV) in comparison to the control group, who did not. Significant differences in the temperature between rest and hyperventilation, with and without a hygroscopic condenser humidifier were also found. In conclusion, a hygroscopic condenser humidifier may be useful in chronically tracheostomized patients who breathe spontaneously, improving viscosity and colouring of secretions, preventing further bacterial colonization, heating inspiratory flow, and helping to improve the functional outcome.

Aged↗
PubMed1994

An unusual increase in haemodynamic values in a sleep apnoea syndrome patient with prolonged apnoea.

This case report shows the results of a right heart catheterisation in a patient with sleep apnoea syndrome (SAS). Arterial oxygen saturation (SaO2), heart rate, oronasal flow, and monitoring of electroencephalographic (EEG), sovrayoidal electromyographic (EMG) and thoracoabdominal movements were recorded simultaneously. A mixed apnoea of 180 s was registered, SaO2 fell to 54% and systolic pulmonary artery pressure (sPAP) increased to 130 mmHg. Slowly, haemodynamic values began to normalise with the reappearance of respiratory acts. We can hypothesize that this patient's nocturnal apnoeas may cause frequent and deep negative pleural pressure swings, with severe continuous action on pulmonary circulation. This case report has shown that a SAS patient is capable of developing an adaptative response to an unusual and remarkable systolic pulmonary artery pressure increase, which is mainly due to hypoxic vasoconstriction.

Adult↗