Sleep Apnea Syndrome and Community Acquired Pneumonia
Condition: Sleep Apnea Syndrome; Polygraphy; Community Acquired Pneumonia; Infections
MeSH terms: Pneumonia; Apnea; Sleep Apnea Syndromes; Syndrome
Study type: Observational

Summary: 
      The association of sleep apnea-hypopnea syndrome (SAHS) with the infections of the lower
      airway has not been studied. The aspiration of secretions of the upper airway and the
      colonization by microorganisms is considered a main event in most of the cases of community
      acquired pneumonia (CAP) , and specially in the nosocomial pneumonia. The silent aspiration
      to the lower airway is a common phenomenon in normal subjects during the sleep and some
      studies has reported that the patients with SAHS present an increase of the risk to
      pharyngeal aspirations. In fact, the presence of nasal and bronchial inflammation in patients
      with SAHS is a recognized event. The patients with SAHS could have a risk increased to
      develop pneumonia due to predisposition to the pharyngeal microaspiration to lower airways
      during the sleep and other mechanical factors associated. The prevalence of SAHS in patients
      with CAP could be increased as regards the data published for the same Spanish population.
      The presence of an apnea-hypopnea index (AHI) could be a risk factor not only to to CAP but
      to to present a unfavorable clinical evolution in comparison to patients with CAP with a
      normal AHI. The aim of this study will establish a relation between SAHS and the pneumonia
      risk.
    

Detailed description: 
      This is a prospective comparative case control study to compare the prevalence of sleep
      apnea-hypopnea syndrome in patients with community acquired pneumonia (CAP).

      Patients hospitalized with CAP (Group A)will be studied with respiratory polygraphy during
      the sleep and a second respiratory polygraphy will be conducted in home after the curation of
      the pneumonia (one month). During the admission, etiological study including blood cultures,
      serology, urinary antigens for legionella and S, pneumoniae, sputum cultures and other
      invasive techniques as bronchoscopy when appropriate will be obtained. Questionnaires related
      with sleep apnea-hypopnea syndrome will be obtained consisting in Epworth test, symptoms
      questionnaires and FOSQ test.

      Group B are patients with other infections as urinary, bone, pelvic infections excluding
      upper or lower respiratory infections. Respiratory polygraphy will be performed in this group
      as in the group A obtaining the same questionnaires.

      We compare the variables of respiratory polygraphy, questionnaires scores, percentage of
      patients with an AHI > 12 between both groups and we compare the variables obtained in the
      respiratory polygraphy performed in hospital and at home in the group A to evaluate if the
      condition of an altered AHI was previous to the CAP episode. We will obtain the prevalence of
      sleep apnea-hypopnea patients in both groups and we compare factor risks (COPD, diabetes
      mellitus, bronchial asthma, etc) between A and B. Finally multivariable analysis is conducted
      to evaluate the contribution of the AHI to CAP, as other recognize factor risk.

      Both groups are paired by age, sex and body mass index
    

Intervention name(s): abbreviated polysomnography
Intervention type(s): Device
Intervention description(s): Both groups will be studied with in-hospital respiratory polygraphy during the sleep. The group A will be studied with another respiratory polygraphy in the home one month after the resolution of CAP. Some questionnaires to measure the sleepiness (Epworth test), FOSQ test, in-home sleepiness questionnaire and symptoms questionary will be obtained in Group A and B
Other intervention name(s): Respiratory Polygraphy; portable polysomnography
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients admitted to hospital with the diagnosis of community acquired pneumonia, excluding
        nosocomial pneumonia compared to patients with other infections excluding respiratory
        infections, admitted to hospital, paired by age, sex and body mass index
      
Keywords: Sleep apnea syndrome; community acquired pneumonia; prevalence