Journal Information
Vol. 34. Issue 4.
Pages 177-183 (April 1998)
Share
Share
Download PDF
More article options
Vol. 34. Issue 4.
Pages 177-183 (April 1998)
Full text access
Síndrome de la apnea obstructiva del sueño en la Comunidad Valenciana: situación actual, estudio de necesidades y perspectivas de futuro
Obstructive sleep apnea syndrome in the Community of Valencia: current situation, needs analysis and future outlook
Visits
3967
E. Chiner1, J.M. Arriero, J. Marco
Sección de Neumología. Hospital Universitari Sant Joan d’Alacant
J. Blanquer*
* Unidad de Cuidados Intensivos Respiratorios. Hospital Clínic Universitari de Valencia
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics

Con el fin de calcular las necesidades de infraestructura en el diagnóstico del síndrome de apnea de sueño (SAS) en la Comunidad Valenciana analizamos los recursos disponibles y el abordaje del SAS en Servicios de Neumología (SNM) y Neurofisiología (SNF) mediante un cuestionario administrado por teléfono en 23 de los 25 hospitales públicos. Sólo el 52% de los SNM y el 56% de los SNF efectuaban estudios de cualquier nivel, siendo de nivel I (polisomnogra-fía convencional) el 42% y el 100%, respectivamente, adscribiéndose a nivel IV (oximetría nocturna) el resto de SNM. Contaban con personal y local específico el 40% y sólo se realizaban estudios domiciliarios en el 17% de hospitales. Aunque el número de estudios anuales es de 2.000, sólo 1.100 son de nivel I, con grandes diferencias en el número por servicios, calculando en 16 meses la demora media. Sólo un hospital efectúa un abordaje multidisciplinario, siendo escasas las relaciones entre SNM y SNF. El número de polisomnógrafos de nivel I es 0,52/250.000 habitantes, y la prevalencia de tratamientos CPAP, de 36/100.000, inferior a otras comunidades. Se concluye que en la Comunidad Valenciana existe una infradotación de recursos técnicos y humanos, en algunos casos infrautilización de los mismos, escaso abordaje multidisciplinario por los diferentes especialistas implicados y largas demoras en el diagnóstico que condicionan la prescripción de tratamiento empírico. Atendiendo a los 100.000 pacientes con SAS calculados en la Comunidad Valenciana, sería necesario disponer de 14 polisomnógrafos frente a los 8 actuales, así como aumentar la dotación de personal para atender la demanda y reducir la demora.

Palabras clave:
Síndrome de la apnea de sueño
Polisomnografía
Recursos

To analyze the infrastructure needs for diagnosing sleep apnea syndrome (SAS) in the Community of Valencia, we studied available resources and the diagnostic approaches to SAS in departments of pneumology and neurophysiology in 23 of the 25 public hospitals by means of a telephone interview. Oniy 52% of pneumology departments and 56% of neurophysiology departments studied SAS at any level. Level I study (conventional polysomnography) was performed by 42% of the pneumology departments and 100% of the neurophysiology departments. The remaining pneumology units used nighttime oxymetry (a level IV technique). A special unit and trained personnel were available at 40% of hospitals. Home studies were performed by oniy 17%. Although 2,000 studies are performed annually, only 1,100 are level I and large interdepartmental differences were detected. The average waiting period was 16 months. Relations between pneumology and neurophysiology units were few and oniy one hospital took an interdisciplinary approach. The ratio of polysomnographs to inhabitants was 0.52/250,000 and the prevalence of nasal continous positive airway pressure treatment was 36/100,000, lower than in other communities. We conclude that Valencia is understaffed and under-equipped, and that in some cases resources are under-used. Interdisciplinary approaches are scarcely used by the various specialists involved and the waiting lists for diagnostic tests required for prescribing empirical treatment are long. To attend the approximately 100,000 SAS patients estimated to reside in Valencia, it woud be necessary to have 14 polysomnograph devices rather than the 8 available now, as well as to increase staff to meet demand and shorten waiting lists.

Key words:
Sleep apnea syndrome
Polisomnography
Resources
Full text is only aviable in PDF
Bibliografía
[1.]
A.E. Phillipson.
Sleep apnea. A major public health problem.
N Engl J Med, 328 (1993), pp. 1.271-1.273
[2.]
J. Wright, R. Johns, I. Watt, A. Melville, T. Sheldon.
Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence.
Br Med J, 314 (1997), pp. 851-860
[3.]
P. Lavie, R. Ben-Yosef, A.E. Rubin.
Prevalence of sleep apnea syndrome among patients with essential hypertension.
Am Heart J, 108 (1984), pp. 373-376
[4.]
E.C. Fletcher.
The relationship between systemic hypertension and obstructive sleep apnea: facts and theory.
Am J Med, 98 (1995), pp. 118-128
[5.]
W.P. Miller.
Cardiac arrhythmias and conduction disturbances in the sleep apnea syndrome.
Am J Med, 73 (1982), pp. 317-321
[6.]
J.W. Shepard Jr., M.W. Garrison, D.A. Grither, et al.
Relationship of ventricular ectopy to nocturnal O2 desaturation in patients with obstructive sleep apnea.
Chest, 88 (1985), pp. 335-340
[7.]
J. Hung, E.G. Whitford, R.W. Parsons, D.R. Hillman.
Association of sleep apnoea with myocardial infarction in man.
Lancet, 336 (1990), pp. 261-264
[8.]
M. Partinen, H. Palomaki.
Snoring and cerebral infarction.
Lancet, 2 (1985), pp. 1.325-1.326
[9.]
T. Seppälä, M. Partinen, A. Penttilä, R. Aspholm, E. Tiainen, A. Kaukianinen.
Sudden death and sleeping history among Finnish men.
J Intern Med, 229 (1991), pp. 23-28
[10.]
J. Montplaisir, M.A. Bedard, F. Richer, I. Rouleau.
Neurobehavioral manifestations in obstructive sleep apnea syndrome before and after treatment with continuous positive airway pressure.
Sleep, 15 (1992), pp. 17-19
[11.]
B. Naegele, V. Thouvard, J.L. Pepin, P. Levy, et al.
Deficits of cognitive executive functions in patients with sleep apnea syndrome.
Sleep, 18 (1995), pp. 43-52
[12.]
R.R. Grunstein, K. Stenlof, J.A. Hedner, L. Sjostrom.
Impact of selfreported sleep-breathing disturbances on psychosocial performance in the swedish obese subjects (SOS) study..
Sleep, 18 (1995), pp. 635-643
[13.]
L. Findley, J. Weiss, E. Jabour.
Serious automobile crashes caused by undetected sleep apnea.
Arch Intern Med, 151 (1991), pp. 1.451-1.452
[14.]
P.O. Haraldsson, C. Carenfelt, C. Tingvall.
Sleep apnea syndrome symptoms and automobile driving in a general population.
J Clin Epidemiol, 45 (1992), pp. 821-825
[15.]
W. Cassel, T. Ploch, C. Becker, D. Dugnus, J.H. Peter, P. Von Wichert.
Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP.
Eur Respir J, 9 (1996), pp. 2.606-2.611
[16.]
J. He, M.H. Kryger, F.J. Zorick, W. Conway, T. Roth.
Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients.
Chest, 94 (1988), pp. 9-14
[17.]
M. Partinen, A. Jamieson, C. Guilleminault.
Long-term outcome for obstructive sleep apnea syndrome patients.
Mortality. Chest, 94 (1988), pp. 1.200-1.204
[18.]
S.S. Derderian, R.H. Bridenbaugh, K.R. Rajagopal.
Neuropsychologic symptoms in obstructive sleep apnea improve after treatment with nasal continuous positive airway pressure.
Chest, 94 (1988), pp. 1.023-1.027
[19.]
T. Young, M. Palta, J. Dempsey, J. Skatrud, S. Weber, S. Badr.
The occurrence of sleep-disordered breathing among middie-aged adults.
N Engl J Med, 328 (1993), pp. 1.230-1.235
[20.]
N.J. Ali, D.J. Pitson, J.R. Stradling.
Snoring, sleep disturbance and behavior in 4-5 year olds.
Arch Dis Child, 68 (1993), pp. 360-366
[21.]
T. Gislason, B. Benediktsdóttir.
Snoring, apneic episodes. and nocturnal hypoxemia among children 6 months to 6 years old. An epidemiologic study of lowcr limit of prevalence.
Chest, 107 (1995), pp. 963-966
[22.]
B. Fleury.
Sleep apnea syndrome in the elderly.
Sleep, 15 (1992), pp. S39-S41
[23.]
S. Esnaola, J. Durán, R. Rubio, A. Iztueta.
Prevalence of obstructive sleep apnoea in the male population of Vitoria-Gasteiz (Spain).
Eur Respir J, 8 (1995), pp. 436
[24.]
C. Zamarron, P. Penela, I. Otero, J.M. Alvarez, et al.
Prevalencia del síndrome de apnea del sueño en nuestra área sanitaria.
Arch Bronconeumol, 31 (1995), pp. 30
[25.]
American Thoracic Socicty.
Indications and standards for cardiopulmonary sleep studies.
Am Rev Respir Dis, 139 (1989), pp. 559-568
[26.]
F. Barbe, J. Amibilia, F. Capote, J. Durán, et al.
Diagnóstico del síndrome de apneas obstructivas durante el sueño.
Informe de Consenso del Área de Insuficiencia Respiratoria y Trastornos del Sueño. Arch Bronconeumol, 31 (1995), pp. 460-462
[27.]
S. Viner, J.P. Szalai, V. Hoffstein.
Are history and physical examination a good screening test for sleep apnea?.
Ann Intern Med, 115 (1991), pp. 356-359
[28.]
J. Durán, J. Amibilia, F. Barbe, F. Capote, et al.
Disponibilidad de recursos técnicos para el diagnóstico y tratamiento del síndrome de apnea obstructiva del sueño en los hospitales de la red pública del Estado.
Arch Bronconeumol, 31 (1995), pp. 463-469
[29.]
ASDA., Standards of Practice.
Portable recording in the assessment of obstructive sleep apnea.
Sleep, 17 (1994), pp. 378-392
[30.]
Conselleria de Sanitat i Consum. Ordre de 27 de desembre de 1993. de la Conselleria de Sanitat i Con.sum, per la qual delimita el mapa sanitari de la Comunitat Valenciana (93/8189). Diari Oficial de la Generalitat Valenciana 1993; 13.690-13.707.
[31.]
Conselleria de Sanitat i Consum. Libro blanco de la salud en la Comunidad Valenciana. Valencia: Generalitat Valenciana, Conselleria de Sanitat i Consum, Gabinete Técnico de la Secretaría General, eds., 1991.
[32.]
S. Esnaola, J. Durán, C. Infante-Rivard, R. Rubio, A. Fernández.
Diagnostic accuracy of a portable recording device (MESAM IV) in suspected obstructive sleep apnoea.
Eur Resp J, 9 (1996), pp. 2.597-2.605
[33.]
W.C. Orr, T. Eiken, V. Pegram, R. Jones, O.H. Rundell.
A laboratory validation study of a portable system for remote recording of sleep-related breating disorders.
Chest, 105 (1994), pp. 160-162
[34.]
T.J. Hoelscher, W.V. McCall, J. Powell, G.R. Marsh, C.W. Erwin.
Two methods for scoring with the Medilog 9000: comparison to conventiona! paper scoring.
Sleep, 2 (1989), pp. 133-139
[35.]
J.M. Montserrat, A. Alarcón, P. Lloberes, E. Ballester, C. Fornas, R. Rodríguez-Roisin.
Adequacy of prescribing nasal continuous positive airway pressure therapy for the sleep apnoea/hypopnoea syndrome on the basis of night time respiratory recording variables.
Thorax, 50 (1995), pp. 969-971
[36.]
A.E. Sher.
Challenges and future trends in the management of obstructive sleep apnea.
Snoring and obstructive sleep apnea, 2.a ed.,
[37.]
M.W. Johns.
Polysomnography at a sleep disorders unit in Melbourne.
Med J Aust, 155 (1991), pp. 303-308
[38.]
E. Chiner.
¿Quién debe coordinar una unidad de patología del sueño?.
Rev Neurol (Barc), 24 (1996), pp. 111-114
Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

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