array:24 [
  "pii" => "S2173511513000596"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2013.07.002"
  "estado" => "S300"
  "fechaPublicacion" => "2013-07-01"
  "aid" => "162"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2013"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "edi"
  "cita" => "Rev Port Pneumol. 2013;19:142-3"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3031
    "formatos" => array:3 [
      "EPUB" => 255
      "HTML" => 1884
      "PDF" => 892
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511513000602"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2013.07.003"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "aid" => "138"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2013;19:144-51"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5718
      "formatos" => array:3 [
        "EPUB" => 258
        "HTML" => 4248
        "PDF" => 1212
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Patients with a high risk for obstructive sleep apnea syndrome&#58; Postoperative respiratory complications"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "144"
          "paginaFinal" => "151"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Doentes com alto risco de Apneia Obstrutiva do Sono&#58; complica&#231;&#245;es respirat&#243;rias p&#243;s-operat&#243;rias"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "H&#46; Pereira, D&#46; Xar&#225;, J&#46; Mendon&#231;a, A&#46; Santos, F&#46;J&#46; Abelha"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "H&#46;"
              "apellidos" => "Pereira"
            ]
            1 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Xar&#225;"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Mendon&#231;a"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Santos"
            ]
            4 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Abelha"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000602?idApp=UINPBA00004E"
    "url" => "/21735115/0000001900000004/v1_201308011255/S2173511513000602/v1_201308011255/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511513000584"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2013.07.001"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "aid" => "161"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Pneumol. 2013;19:141"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2521
      "formatos" => array:3 [
        "EPUB" => 251
        "HTML" => 1487
        "PDF" => 783
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Is it worthwhile&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "141"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Ser&#225; que vale a pena&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Morais"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Morais"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000584?idApp=UINPBA00004E"
    "url" => "/21735115/0000001900000004/v1_201308011255/S2173511513000584/v1_201308011255/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Obstructive Sleep Apnea and Surgery&#58; Wake up for the problem&#33;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "142"
        "paginaFinal" => "143"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Geraldo Lorenzi-Filho, Pedro Rodrigues Genta, Luciano Drager"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Geraldo"
            "apellidos" => "Lorenzi-Filho"
            "email" => array:1 [
              0 => "geraldo&#46;lorenzi&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Pedro Rodrigues"
            "apellidos" => "Genta"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luciano"
            "apellidos" => "Drager"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Pulmonary Division&#44; Sleep Laboratory of the Heart Institute&#44; Faculty of Medicine&#44; University of S&#227;o Paulo&#44; S&#227;o Paulo&#44; Brazil"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cardiology Division&#44; Sleep Laboratory of the Heart Institute&#44; Faculty of Medicine&#44; University of S&#227;o Paulo&#44; S&#227;o Paulo&#44; Brazil"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Apneia Obstrutiva do Sono e Cirurgia&#58; prestem aten&#231;&#227;o"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Obstructive sleep apnea &#40;OSA&#41; is a common disease characterized by repetitive obstruction of the upper airways during sleep&#46; It is now recognized that OSA is much more prevalent than previously thought&#46; For instance&#44; one recent study of a representative sample of the city of S&#227;o Paulo&#44; Brazil&#44; found that 33&#37; of the adult population presented OSA syndrome as defined by full polysomnography showing an apnea-hypopnea index above 5 events&#47;hour plus symptoms or an apnea-hypopnea index &#62;<span class="elsevierStyleHsp" style=""></span>15 events per hour independent of symptoms<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The prevalence of OSA may be even higher among specific populations for at least 2 reasons&#46; Firstly&#44; because OSA shares several risk factors with common conditions such as obesity&#44; hypertension and diabetes and secondly&#44; OSA once present triggers a series of pathways that may negatively affect co-morbid conditions such as high blood pressure and insulin resistance<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Independently of the exact mechanism&#44; it is well Known that among patients with established diagnosis of hypertension<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; resistant hypertension<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and metabolic syndrome<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> the prevalence of OSA is strikingly high and varies from 30 to 70&#37;&#46; The recognition of OSA among surgical patients is particularly important&#46; Despite the fact that awareness is still low&#44; one should anticipate a high prevalence of OSA solely based solely on the presence of the demographic and clinical conditions commonly observed in this population&#46; In addition&#44; although not fully established&#44; it is clear that there may be an association between unrecognized OSA and the increased risk of post operative complications&#46; Finally&#44; the pre-operative setting is a good time to investigate co-morbidities because patients may be more receptive to lifestyle and medical interventions&#46; On the other hand&#44; a major limitation in the recognition of OSA is the limited access to the full polysomnography that is considered the gold standard method for OSA diagnosis&#46; In this context&#44; screening questionnaires are important in facilitating identification of OSA patients and in keeping down costs&#46; In this issue of the Portuguese Journal of Pulmonology&#44; Pereira and colleagues evaluated the prevalence of OSA symptoms using a validated questionnaire &#40;STOP-BANG score&#41; in 357 surgical patients admitted to the Post-Anesthesia Care Unit<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; The STOP-BANG questionnaire has been designed to detect OSA in the surgical population and presents a high sensitivity to detecting OSA&#44; but has a low specificity&#46; The positive questionnaire may result in a high number of false-positives&#46; Therefore&#44; if the primary goal is to include all cases of OSA&#44; the STOP-BANG questionnaire is a good option&#44; but ideally the final diagnosis would require a diagnostic test&#46; One interesting option for OSA diagnosis in the surgical population is the use of portable monitoring which has been previously validated among patients waiting for coronary artery bypass surgery<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;The prevalence of patients with traits that are suggestive of OSA as evaluated by the STOP-BANG questionnaire in the study of Pereira and colleagues was very high &#40;slightly over 50&#37;&#41;&#46; The estimated prevalence of OSA is striking&#44; and clearly suggests that the vast majority of the patients in the surgical population remain undiagnosed&#46; More importantly&#44; the authors also showed that patients with suggestive of OSA were more likely to present post operative complications&#46; The question not answered in this study is whether OSA is in fact an independent risk factor for complications&#44; or whether co-variables such as obesity or other co-morbid conditions&#44; could fully explain the negative association&#46; In conclusion&#44; the paper by Pereira et al raises several important questions about the identification and consequences of OSA in the perioperative period&#46; Further research on the impact of recognition and treatment of OSA in the population of patients submitted to surgeries should be mandatory&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-06-12"
    "fechaAceptado" => "2013-06-12"
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Tufik"
                            1 => "R&#46; Santos-Silva"
                            2 => "J&#46;A&#46; Taddei"
                            3 => "L&#46;R&#46; Bittencourt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.sleep.2009.10.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sleep Med"
                        "fecha" => "2010"
                        "volumen" => "11"
                        "paginaInicial" => "441"
                        "paginaFinal" => "446"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20362502"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea&#58; an emerging risk factor for atherosclerosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;F&#46; Drager"
                            1 => "V&#46;Y&#46; Polotsky"
                            2 => "G&#46; Lorenzi-Filho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-2223"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2011"
                        "volumen" => "140"
                        "paginaInicial" => "534"
                        "paginaFinal" => "542"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21813534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics and predictors of obstructive sleep apnea in patients with systemic hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "L&#46;F&#46; Drager"
                            1 => "P&#46;R&#46; Genta"
                            2 => "R&#46;P&#46; Pedrosa"
                            3 => "F&#46;B&#46; Nerbass"
                            4 => "C&#46;C&#46; Gonzaga"
                            5 => "E&#46;M&#46; Krieger"
                            6 => "G&#46; Lorenzi-Filho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2009.12.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "1135"
                        "paginaFinal" => "1139"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20381666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea&#58; the most common secondary cause of hypertension associated with resistant hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:11 [
                            0 => "R&#46;P&#46; Pedrosa"
                            1 => "L&#46;F&#46; Drager"
                            2 => "C&#46;C&#46; Gonzaga"
                            3 => "M&#46;G&#46; Sousa"
                            4 => "L&#46;K&#46; de Paula"
                            5 => "A&#46;C&#46; Amaro"
                            6 => "C&#46; Amodeo"
                            7 => "L&#46;A&#46; Bortolotto"
                            8 => "E&#46;M&#46; Krieger"
                            9 => "T&#46;D&#46; Bradley"
                            10 => "G&#46; Lorenzi-Filho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.111.179788"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2011"
                        "volumen" => "58"
                        "paginaInicial" => "811"
                        "paginaFinal" => "817"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21968750"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;F&#46; Drager"
                            1 => "H&#46;F&#46; Lopes"
                            2 => "C&#46; Maki-Nunes"
                            3 => "I&#46;C&#46; Trombetta"
                            4 => "E&#46; Toschi-Dias"
                            5 => "M&#46;J&#46; Alves"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0012065"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2010 Aug 11"
                        "volumen" => "5"
                        "paginaInicial" => "e12065"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20711453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patients with high risk for obstructive sleep apnea syndrome&#58; Postoperative respiratory complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Pereira"
                            1 => "D&#46; Xar&#225;"
                            2 => "J&#46; Mendon&#231;a"
                            3 => "A&#46; Santos"
                            4 => "F&#46; Abelha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2013"
                        "itemHostRev" => array:3 [
                          "pii" => "S073510970600800X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;10&#46;1016&#47;j&#46;rppneu&#46;2013&#46;01&#46;003"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;J&#46; Danzi-Soares"
                            1 => "P&#46;R&#46; Genta"
                            2 => "F&#46;B&#46; Nerbass"
                            3 => "R&#46;P&#46; Pedrosa"
                            4 => "F&#46;S&#46; Soares"
                            5 => "L&#46;A&#46; C&#233;sar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCA.0b013e32834df5d0"
                      "Revista" => array:7 [
                        "tituloSerie" => "Coron Artery Dis"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "31"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22107804"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109712000940"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000001900000004/v1_201308011255/S2173511513000596/v1_201308011255/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9716"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001900000004/v1_201308011255/S2173511513000596/v1_201308011255/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000596?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
Obstructive Sleep Apnea and Surgery: Wake up for the problem!
Apneia Obstrutiva do Sono e Cirurgia: prestem atenção
Geraldo Lorenzi-Filhoa,
Corresponding author
geraldo.lorenzi@gmail.com

Corresponding author.
, Pedro Rodrigues Gentaa, Luciano Dragerb
a Pulmonary Division, Sleep Laboratory of the Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
b Cardiology Division, Sleep Laboratory of the Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
Read
850
Times
was read the article
466
Total PDF
384
Total HTML
Share statistics
 array:24 [
  "pii" => "S2173511513000596"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2013.07.002"
  "estado" => "S300"
  "fechaPublicacion" => "2013-07-01"
  "aid" => "162"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2013"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "edi"
  "cita" => "Rev Port Pneumol. 2013;19:142-3"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 3031
    "formatos" => array:3 [
      "EPUB" => 255
      "HTML" => 1884
      "PDF" => 892
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511513000602"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2013.07.003"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "aid" => "138"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2013;19:144-51"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5718
      "formatos" => array:3 [
        "EPUB" => 258
        "HTML" => 4248
        "PDF" => 1212
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Patients with a high risk for obstructive sleep apnea syndrome&#58; Postoperative respiratory complications"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "144"
          "paginaFinal" => "151"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Doentes com alto risco de Apneia Obstrutiva do Sono&#58; complica&#231;&#245;es respirat&#243;rias p&#243;s-operat&#243;rias"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "H&#46; Pereira, D&#46; Xar&#225;, J&#46; Mendon&#231;a, A&#46; Santos, F&#46;J&#46; Abelha"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "H&#46;"
              "apellidos" => "Pereira"
            ]
            1 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Xar&#225;"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Mendon&#231;a"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Santos"
            ]
            4 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Abelha"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000602?idApp=UINPBA00004E"
    "url" => "/21735115/0000001900000004/v1_201308011255/S2173511513000602/v1_201308011255/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511513000584"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2013.07.001"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "aid" => "161"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Pneumol. 2013;19:141"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2521
      "formatos" => array:3 [
        "EPUB" => 251
        "HTML" => 1487
        "PDF" => 783
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Is it worthwhile&#63;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "141"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Ser&#225; que vale a pena&#63;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Morais"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Morais"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000584?idApp=UINPBA00004E"
    "url" => "/21735115/0000001900000004/v1_201308011255/S2173511513000584/v1_201308011255/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Obstructive Sleep Apnea and Surgery&#58; Wake up for the problem&#33;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "142"
        "paginaFinal" => "143"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Geraldo Lorenzi-Filho, Pedro Rodrigues Genta, Luciano Drager"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Geraldo"
            "apellidos" => "Lorenzi-Filho"
            "email" => array:1 [
              0 => "geraldo&#46;lorenzi&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Pedro Rodrigues"
            "apellidos" => "Genta"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Luciano"
            "apellidos" => "Drager"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Pulmonary Division&#44; Sleep Laboratory of the Heart Institute&#44; Faculty of Medicine&#44; University of S&#227;o Paulo&#44; S&#227;o Paulo&#44; Brazil"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cardiology Division&#44; Sleep Laboratory of the Heart Institute&#44; Faculty of Medicine&#44; University of S&#227;o Paulo&#44; S&#227;o Paulo&#44; Brazil"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Apneia Obstrutiva do Sono e Cirurgia&#58; prestem aten&#231;&#227;o"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Obstructive sleep apnea &#40;OSA&#41; is a common disease characterized by repetitive obstruction of the upper airways during sleep&#46; It is now recognized that OSA is much more prevalent than previously thought&#46; For instance&#44; one recent study of a representative sample of the city of S&#227;o Paulo&#44; Brazil&#44; found that 33&#37; of the adult population presented OSA syndrome as defined by full polysomnography showing an apnea-hypopnea index above 5 events&#47;hour plus symptoms or an apnea-hypopnea index &#62;<span class="elsevierStyleHsp" style=""></span>15 events per hour independent of symptoms<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The prevalence of OSA may be even higher among specific populations for at least 2 reasons&#46; Firstly&#44; because OSA shares several risk factors with common conditions such as obesity&#44; hypertension and diabetes and secondly&#44; OSA once present triggers a series of pathways that may negatively affect co-morbid conditions such as high blood pressure and insulin resistance<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Independently of the exact mechanism&#44; it is well Known that among patients with established diagnosis of hypertension<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; resistant hypertension<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and metabolic syndrome<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> the prevalence of OSA is strikingly high and varies from 30 to 70&#37;&#46; The recognition of OSA among surgical patients is particularly important&#46; Despite the fact that awareness is still low&#44; one should anticipate a high prevalence of OSA solely based solely on the presence of the demographic and clinical conditions commonly observed in this population&#46; In addition&#44; although not fully established&#44; it is clear that there may be an association between unrecognized OSA and the increased risk of post operative complications&#46; Finally&#44; the pre-operative setting is a good time to investigate co-morbidities because patients may be more receptive to lifestyle and medical interventions&#46; On the other hand&#44; a major limitation in the recognition of OSA is the limited access to the full polysomnography that is considered the gold standard method for OSA diagnosis&#46; In this context&#44; screening questionnaires are important in facilitating identification of OSA patients and in keeping down costs&#46; In this issue of the Portuguese Journal of Pulmonology&#44; Pereira and colleagues evaluated the prevalence of OSA symptoms using a validated questionnaire &#40;STOP-BANG score&#41; in 357 surgical patients admitted to the Post-Anesthesia Care Unit<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; The STOP-BANG questionnaire has been designed to detect OSA in the surgical population and presents a high sensitivity to detecting OSA&#44; but has a low specificity&#46; The positive questionnaire may result in a high number of false-positives&#46; Therefore&#44; if the primary goal is to include all cases of OSA&#44; the STOP-BANG questionnaire is a good option&#44; but ideally the final diagnosis would require a diagnostic test&#46; One interesting option for OSA diagnosis in the surgical population is the use of portable monitoring which has been previously validated among patients waiting for coronary artery bypass surgery<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;The prevalence of patients with traits that are suggestive of OSA as evaluated by the STOP-BANG questionnaire in the study of Pereira and colleagues was very high &#40;slightly over 50&#37;&#41;&#46; The estimated prevalence of OSA is striking&#44; and clearly suggests that the vast majority of the patients in the surgical population remain undiagnosed&#46; More importantly&#44; the authors also showed that patients with suggestive of OSA were more likely to present post operative complications&#46; The question not answered in this study is whether OSA is in fact an independent risk factor for complications&#44; or whether co-variables such as obesity or other co-morbid conditions&#44; could fully explain the negative association&#46; In conclusion&#44; the paper by Pereira et al raises several important questions about the identification and consequences of OSA in the perioperative period&#46; Further research on the impact of recognition and treatment of OSA in the population of patients submitted to surgeries should be mandatory&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-06-12"
    "fechaAceptado" => "2013-06-12"
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:7 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea syndrome in the Sao Paulo Epidemiologic Sleep Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Tufik"
                            1 => "R&#46; Santos-Silva"
                            2 => "J&#46;A&#46; Taddei"
                            3 => "L&#46;R&#46; Bittencourt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.sleep.2009.10.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sleep Med"
                        "fecha" => "2010"
                        "volumen" => "11"
                        "paginaInicial" => "441"
                        "paginaFinal" => "446"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20362502"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea&#58; an emerging risk factor for atherosclerosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;F&#46; Drager"
                            1 => "V&#46;Y&#46; Polotsky"
                            2 => "G&#46; Lorenzi-Filho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-2223"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2011"
                        "volumen" => "140"
                        "paginaInicial" => "534"
                        "paginaFinal" => "542"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21813534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Characteristics and predictors of obstructive sleep apnea in patients with systemic hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "L&#46;F&#46; Drager"
                            1 => "P&#46;R&#46; Genta"
                            2 => "R&#46;P&#46; Pedrosa"
                            3 => "F&#46;B&#46; Nerbass"
                            4 => "C&#46;C&#46; Gonzaga"
                            5 => "E&#46;M&#46; Krieger"
                            6 => "G&#46; Lorenzi-Filho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.amjcard.2009.12.017"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Cardiol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "1135"
                        "paginaFinal" => "1139"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20381666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea&#58; the most common secondary cause of hypertension associated with resistant hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:11 [
                            0 => "R&#46;P&#46; Pedrosa"
                            1 => "L&#46;F&#46; Drager"
                            2 => "C&#46;C&#46; Gonzaga"
                            3 => "M&#46;G&#46; Sousa"
                            4 => "L&#46;K&#46; de Paula"
                            5 => "A&#46;C&#46; Amaro"
                            6 => "C&#46; Amodeo"
                            7 => "L&#46;A&#46; Bortolotto"
                            8 => "E&#46;M&#46; Krieger"
                            9 => "T&#46;D&#46; Bradley"
                            10 => "G&#46; Lorenzi-Filho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/HYPERTENSIONAHA.111.179788"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "2011"
                        "volumen" => "58"
                        "paginaInicial" => "811"
                        "paginaFinal" => "817"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21968750"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The impact of obstructive sleep apnea on metabolic and inflammatory markers in consecutive patients with metabolic syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;F&#46; Drager"
                            1 => "H&#46;F&#46; Lopes"
                            2 => "C&#46; Maki-Nunes"
                            3 => "I&#46;C&#46; Trombetta"
                            4 => "E&#46; Toschi-Dias"
                            5 => "M&#46;J&#46; Alves"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0012065"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2010 Aug 11"
                        "volumen" => "5"
                        "paginaInicial" => "e12065"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20711453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patients with high risk for obstructive sleep apnea syndrome&#58; Postoperative respiratory complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Pereira"
                            1 => "D&#46; Xar&#225;"
                            2 => "J&#46; Mendon&#231;a"
                            3 => "A&#46; Santos"
                            4 => "F&#46; Abelha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2013"
                        "itemHostRev" => array:3 [
                          "pii" => "S073510970600800X"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "http&#58;&#47;&#47;dx&#46;doi&#46;org&#47;10&#46;1016&#47;10&#46;1016&#47;j&#46;rppneu&#46;2013&#46;01&#46;003"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea is common among patients referred for coronary artery bypass grafting and can be diagnosed by portable monitoring"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;J&#46; Danzi-Soares"
                            1 => "P&#46;R&#46; Genta"
                            2 => "F&#46;B&#46; Nerbass"
                            3 => "R&#46;P&#46; Pedrosa"
                            4 => "F&#46;S&#46; Soares"
                            5 => "L&#46;A&#46; C&#233;sar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCA.0b013e32834df5d0"
                      "Revista" => array:7 [
                        "tituloSerie" => "Coron Artery Dis"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "31"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22107804"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109712000940"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000001900000004/v1_201308011255/S2173511513000596/v1_201308011255/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9716"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001900000004/v1_201308011255/S2173511513000596/v1_201308011255/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511513000596?idApp=UINPBA00004E"
]
Article information
ISSN: 21735115
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 4 2 6
2024 September 32 48 80
2024 August 41 35 76
2024 July 20 29 49
2024 June 22 19 41
2024 May 29 33 62
2024 April 24 21 45
2024 March 24 23 47
2024 February 23 21 44
2024 January 23 27 50
2023 December 12 27 39
2023 November 24 32 56
2023 October 15 29 44
2023 September 14 28 42
2023 August 18 19 37
2023 July 17 27 44
2023 June 11 12 23
2023 May 20 23 43
2023 April 11 11 22
Show all

Follow this link to access the full text of the article

Pulmonology

Are you a health professional able to prescribe or dispense drugs?