1
|
Drager LF, Santos RB, Pachito D, Albertini CS, Sert Kuniyoshi FH, Eckeli AL. Inequalities in the access to diagnosis and treatment of obstructive sleep apnea in Brazil: a cross-sectional study. J Clin Sleep Med 2024; 20:735-742. [PMID: 38169439 PMCID: PMC11063704 DOI: 10.5664/jcsm.10976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is highly prevalent, and positive airway pressure (PAP) therapy is the primary treatment. This study aimed to assess the diagnostic and PAP treatment resources for OSA within Brazil's Unified Health System and to identify potential inequalities and gaps. METHODS A structured survey was sent to members of the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine to identify sleep laboratories providing OSA diagnosis and/or treatment within Brazil's Unified Health System. The numbers of centers, care team structure, sleep studies availability, PAP accessibility, and follow-up services were characterized in all 5 Brazilian regions. RESULTS Forty-seven centers were identified: Midwest (n = 4), Northeast (n = 10), North (n = 3), Southeast (n = 22), and South (n = 8). Most centers (70%) provided both OSA diagnosis and treatment, mainly in capitals and/or metropolises (87%). Ten out of 27 Brazilian Federal Units lacked sleep services for OSA management, with the North having the highest proportion of states without a sleep service (71%). The annual number of diagnostic exams for OSA was 14,932, with significant heterogeneity across regions (Midwest: 240; North: 400; Northeast: 3,564; South: 4,380; Southeast: 6,348). Mean waiting times for diagnosis and treatment were 11 and 8 months, respectively. Only 46% of PAP treatments were publicly funded, making legal injunctions and out-of-pocket expenditure common practices. CONCLUSIONS This study revealed significant disparities in OSA diagnosis and treatment resources across Brazil, with the North region being particularly underserved. The findings underscore an urgent need for strategies to improve sleep care nationwide. CITATION Drager LF, Santos RB, Pachito D, Albertini CS, Sert Kuniyoshi FH, Eckeli AL. Inequalities in the access to diagnosis and treatment of obstructive sleep apnea in Brazil: a cross-sectional study. J Clin Sleep Med. 2024;20(5):735-742.
Collapse
Affiliation(s)
- Luciano F. Drager
- Unidades de Hipertensão, Instituto do Coração (InCor) e Disciplina de Nefrologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
- Brazilian Sleep Association (ABS), Sao Paulo, Brazil
| | - Ronaldo B. Santos
- Hospital Universitário, Universidade de São Paulo, Sao Paulo, Brazil
| | | | - Claudia S. Albertini
- Laboratório do Sono, Divisão de Pneumologia, Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Fatima H. Sert Kuniyoshi
- ResMed Science Center, San Diego, California
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alan L. Eckeli
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Sao Paulo, Brazil
- Brazilian Association of Sleep Medicine (ABMS), Sao Paulo, Brazil
| |
Collapse
|
2
|
Navarrete-Martínez E, Muñoz-Gómez R, Serrano-Merino J, Perula-de Torres LA, Vaquero-Abellán M, Silva-Gil F, Roldán-Villalobos A, Martín-Rioboó E, Ruiz-Moruno J, Romero-Rodríguez E, González-Lama J, Montes-Redondo G. Validity and reliability of the Berlin questionnaire for the detection of moderate or severe obstructive sleep apnea in patients aged 40 years or older detected from primary care. Front Med (Lausanne) 2023; 10:1229972. [PMID: 37644989 PMCID: PMC10461081 DOI: 10.3389/fmed.2023.1229972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023] Open
Abstract
Background The obstructive sleep apnea syndrome (OSA) is a highly prevalent condition. In Spain and other countries, only 5%-9% of patients with OSA have been diagnosed and treated. The lack of accessibility to diagnosis is considered the main cause of this situation through easy-to-use screening instruments, it is necessary to check their validity and reliability in the context where they are to be used. Objective To validate the Spanish translation of the Berlin questionnaire for screening for moderate or severe OSA in patients aged 40 years or more detected in primary care. Methods A descriptive observational study, with a first qualitative phase of transcultural adaptation to Spanish using the translation-back-translation method. Setting: primary care level of the Spanish National Health System. A total of 255 patients recruited from 7 healthcare centers completed the study. The Berlin questionnaire was administered to the recruited patients, and subsequently, a respiratory polygraphy was performed to confirm the diagnosis of OSA. The concurrent criterion validity of the questionnaire and its reliability in terms of internal consistency and reproducibility (intra-observer agreement) were analyzed. Results The patients' mean age was 54.76 years (SD: 6.57; 95% CI: 53.53-54.99), and 54.12% were men (95% CI: 47.96-60.27). We found that 61.57% (95% CI: 55.57-67.57) presented OSA (apnea-hypopnea index-AHI >5), and 45.5% (95% CI: 17.05-57.92) presented moderate or severe (AHI >15) OSA. The Berlin questionnaire, with a cut-off point of 4.5, showed a sensitivity of 76.77% (95% CI: 67.94-85.59), a specificity of 74.49% (95% CI: 65.35-83.63), a positive predictive value of 75.25% (95% CI: 66.34-84.16), a negative predictive value of 76.04% (95% CI: 66.98-85.10), and an area under the curve of 0.786 (95% CI: 0.721-0.851). Cronbach's alpha coefficient was 0.730 (95% CI: 0.668-0.784), and the Kappa index was 0.739 (95% CI, 0.384-1.000). Conclusion The Spanish adaptation of the Berlin questionnaire has good validity and reliability as a test for the diagnostic screening of moderate or severe OSA in patients aged 40 years or older. The findings of our study confirm that primary care physicians should use such screening tools to predict OSA.
Collapse
Affiliation(s)
- Esther Navarrete-Martínez
- Marchena Health Center, Osuna Sanitary Area, Seville, Spain
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
| | - Rafaela Muñoz-Gómez
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Sector Sur Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
| | - Jesús Serrano-Merino
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Sector Sur Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
| | - Luis Angel Perula-de Torres
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Program of Preventive Activities and Health Promotion (PAPPS), semFYC, Barcelona, Spain
| | - Manuel Vaquero-Abellán
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Fátima Silva-Gil
- Pedro Abad Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
| | - Ana Roldán-Villalobos
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Carlos Castilla del Pino Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
| | - Enrique Martín-Rioboó
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Sector Sur Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
- Poniente Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
| | - Javier Ruiz-Moruno
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Aeropuerto Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
| | - Esperanza Romero-Rodríguez
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Carlos Castilla del Pino Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
| | - Jesús González-Lama
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Program of Preventive Activities and Health Promotion (PAPPS), semFYC, Barcelona, Spain
- Cabra Health Center, Sanitary Management Area South of Córdoba, Córdoba, Spain
- Group/Program Communication and Health, semFYC, Barcelona, Spain
| | - Gertrudis Montes-Redondo
- Maimonides Institute for Biomedical Research of Córdoba (IMIBIC)/Reina Sofía Hospital/University of Córdoba, Córdoba, Spain
- Santa Rosa Health Center, Córdoba-Guadalquivir Health District, Córdoba, Spain
| |
Collapse
|
3
|
Muñoz-Gómez R, Navarrete-Martínez E, Serrano-Merino J, Silva-Gil F, Roldán-Villalobos A, Martín-Rioboó E, Ruiz-Moruno J, Romero-Rodríguez E, Gonzalez-Lama J, Vaquero-Abellán M, Perula-de-Torres LA. The usefulness of the Spanish version of the STOP-Bang questionnaire for screening for moderate or severe sleep apnea syndrome in primary care. Front Public Health 2022; 10:975114. [PMID: 36159274 PMCID: PMC9502031 DOI: 10.3389/fpubh.2022.975114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023] Open
Abstract
Rationale Sleep apnea-hypopnea syndrome (OSA) is a highly prevalent disease and has been related to cardiovascular diseases and occupational and traffic accidents. Currently, it is estimated that there is a significant underdiagnosis of OSA, mainly due to the difficulty accessing the tests for that purpose. Objective To determine the usefulness of the Spanish version of the STOP-Bang questionnaire (SBQ) for screening for moderate or severe OSA in the adult population attending primary care. Methods A descriptive observational multicenter study was conducted. Through an opportunistic search, (patients over 18 years old), were recruited in seven primary care centers. The SBQ was applied to them and home respiratory polygraphy (HRP) was subsequently performed to confirm the diagnosis of OSA. The criterion validity of the SBQ was analyzed, comparing the score obtained by the SBQ with the apnea-hypopnea index (AHI) obtained by RP, establishing the diagnosis of OSA for an AHI>5. The reliability of the questionnaire was evaluated. Results A total of 255 subjects, 54.1% men, with a mean age of 54.76 ± 10 years, were recruited in the study. The results showed that 61.57% (95% Confidence Interval: 55.57-67.57) of the subjects presented OSA, presenting 22.75% (17.57-57.92) a mild OSA (530) (11.54-20.62). The Kuder and Richardson coefficient was 0.623 (0.335-0.788) and Cohen's Kappa coefficient was 0.871 (0.520-1.00; p < 0.001). For moderate/severe OSA screening (AHI>15) the SBQ obtained an ROC curve of 0.769 (0.704-0.833) that with an optimal cutoff of 3, achieved a sensitivity of 84.85% (77.28-92.42) and a specificity of 55.10% (44.74-65.46). Conclusions The SBQ is very effective for detecting moderate/severe OSA. Its psychometric properties are similar to those obtained in studies on other populations. Because of its ease of use, the SBQ is a very useful tool for primary health care professionals.
Collapse
Affiliation(s)
- Rafaela Muñoz-Gómez
- Centro de Salud Sector Sur, Distrito Sanitario Córdoba-Guadalquivir, Distrito Sanitario Córdoba Guadalquivir, Córdoba, Spain,Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Esther Navarrete-Martínez
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Centro de Salud de Marchena, Área de Gestión Sanitaria Osuna-Sureste Sevilla, Sevilla, Spain
| | - Jesús Serrano-Merino
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Centro de Salud Sector Sur, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain,*Correspondence: Jesús Serrano-Merino
| | - Fátima Silva-Gil
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Centro de Salud Pedro Abad, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Ana Roldán-Villalobos
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Centro de Salud Castilla del Pino, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Enrique Martín-Rioboó
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Centro de Salud Poniente, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Javier Ruiz-Moruno
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Centro de Salud Aeropuerto, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Esperanza Romero-Rodríguez
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Centro de Salud Castilla del Pino, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain,Unidad docente multiprofesional de atención familiar y comunitaria, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| | - Jesus Gonzalez-Lama
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Centro de Salud de Cabra, Área de Gestión Sanitaria Sur de Córdoba, Córdoba, Spain
| | - Manuel Vaquero-Abellán
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Facultad de Medicina y Enfermería, Universidad de Córdoba, Cordoba, Spain
| | - Luis Angel Perula-de-Torres
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain,Unidad docente multiprofesional de atención familiar y comunitaria, Distrito Sanitario Córdoba-Guadalquivir, Córdoba, Spain
| |
Collapse
|
4
|
Derivation and validation of a clinical prediction rule for sleep apnoea syndrome for use in primary care. BJGP Open 2018; 2:bjgpopen18X101481. [PMID: 30564714 PMCID: PMC6184092 DOI: 10.3399/bjgpopen18x101481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/06/2018] [Indexed: 12/05/2022] Open
Abstract
Background Several clinical prediction rules (CPRs) are available for sleep apnoea-hypopnoea syndrome (OSAH), but they are difficult to apply in primary care (PC). Aim Derivation and validation of a CPR using simple measurements available in PC. Design & setting A prospective study conducted in health centres from the area of influence of three Spanish hospitals. Method Patients (aged 18–70 years) who attended for any reason; who presented with at least one of the three key symptoms for OSAH (snoring, breathing pauses while sleeping, and daytime sleepiness); and who were not undergoing non-invasive ventilation or prior treatment with continuous positive airway pressure (CPAP) were included. Anthropometric data, smoking habit, comorbidities, and Epworth test were collected. Patients were subsequently referred to the sleep unit (SU), where the decision was taken whether or not to instigate treatment. A multivariate logistic model was constructed using a sub-sample and scores assigned based on the regression coefficients; the CPR was validated with the remaining sample. Both receiver operating characteristic (ROC) curves were plotted and the sensitivity, specificity, and predictive values calculated. Results The derivation sample comprised 352 patients, with 260 in the validation sample. The final factors (arterial hypertension [AHT], age, body mass index [BMI], and sex) were used to develop a rule with scores ranging from 0.00–5.50. The cut-off point that optimises the area under the curve (AUC) is ≥2.50 points (AUC = 0.78; sensitivity = 86%; specificity = 54%; positive predictive value [PPV] = 45%; negative predictive value [NPV] = 90%; likelihood ratio [LR] = 0.26). The properties for the validation sample with this cut-off point are as follows: AUC = 0.68; sensitivity = 81%; specificity = 43%; PPV = 61%; NPV = 68%; LR = 0.44. Conclusion As in similar cases, the specificity is low, meaning that healthy people are referred to a specialist. A negative result rules out the disease in most cases.
Collapse
|
5
|
Durán-Cantolla J, Zamora Almeida G, Vegas Diaz de Guereñu O, Saracho Rotaeche L, Hamdan Alkhraisat M, Durán Carro J, Egea Santaolalla C, Anitua E. Validation of a new domiciliary diagnosis device for automatic diagnosis of patients with clinical suspicion of OSA. Respirology 2016; 22:378-385. [DOI: 10.1111/resp.12894] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/01/2016] [Accepted: 06/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joaquín Durán-Cantolla
- Bioaraba Research Institute; OSI Araba University Hospital; Vitoria Spain
- Interdisciplinary Sleep Unit; OSI Araba University Hospital; Vitoria Spain
- Medicine Department; Basque Country University; Vitoria Spain
- Ciber de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - Gabriela Zamora Almeida
- Bioaraba Research Institute; OSI Araba University Hospital; Vitoria Spain
- Interdisciplinary Sleep Unit; OSI Araba University Hospital; Vitoria Spain
| | | | | | | | - Joaquín Durán Carro
- Bioaraba Research Institute; OSI Araba University Hospital; Vitoria Spain
- Interdisciplinary Sleep Unit; OSI Araba University Hospital; Vitoria Spain
| | - Carlos Egea Santaolalla
- Bioaraba Research Institute; OSI Araba University Hospital; Vitoria Spain
- Interdisciplinary Sleep Unit; OSI Araba University Hospital; Vitoria Spain
| | | | | |
Collapse
|
6
|
Durán-Cantolla J, Crovetto-Martínez R, Alkhraisat MH, Crovetto M, Municio A, Kutz R, Aizpuru F, Miranda E, Anitua E. Efficacy of mandibular advancement device in the treatment of obstructive sleep apnea syndrome: A randomized controlled crossover clinical trial. Med Oral Patol Oral Cir Bucal 2015; 20:e605-15. [PMID: 26241460 PMCID: PMC4598931 DOI: 10.4317/medoral.20649] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 03/31/2015] [Indexed: 12/04/2022] Open
Abstract
Background Evaluation of the efficacy and safety of a mandibular advancement device (MAD) (KlearwayTM) in the treatment of mild-to-moderate obstructive sleep apnea and chronic roncopathy. Material and Methods A randomized, placebo-controlled, double blinded, and crossover clinical trial was conducted. Placebo device (PD) defined as a splint in the centric occlusion that did not induce a mandibular advancement served as a control. The mandible was advanced to the maximum tolerable distance or to a minimum of 65% of the maximum protrusion. After each sequence of treatment, patients were assessed by questionnaires, conventional polysomnography, and objective measurement of snoring at the patient’s own home. Results Forty two patients participated in the study and 38 completed the study. Patients mean age was 46 ±9 years and the 79% were males. The mean mandibular advancement was 8.6 ±2.8 mm. Patients used the MAD and the PD for 6.4 +2.4 hours and 6.2 +2.0 hours, respectively. Secondary effects (mostly mild) occurred in the 85.7% and the 86.8% of the users of MAD and PD, respectively. The MAD induced a decrease in the apnea-hypopnea index (AHI) from 15.3 +10.2 to 11.9 +15.5. The 50% reduction in the AHI was achieved in the 46.2% and the 18.4% of the patients treated with MAD and PD, respectively. The use of the MAD induced a reduction in the AHI by 3.4 +15.9 while the PD induced an increase by 10.6 +26.1. The subjective evaluation of the roncopathy indicated an improvement by the MAD and an increase in the perceptive quality of sleep. However, the objective evaluation of the roncopathy did not show significant improvements. Conclusions The use of MAD is efficient to reduce the AHI and improve subjectively the roncopathy. MAD could be considered in the treatment of mild-to-moderate OSA and chronic roncopathy. Key words:Obstructive sleep apnea (OSA), mandibular advance device, treatment, efficacy, clinical assay.
Collapse
Affiliation(s)
- Joaquín Durán-Cantolla
- Servicio de Investigación, Instituto de Investigación BioAraba, Hospital Universitario Araba, C, José Achotegui sn, Planta 4 C, despacho 417, Vitoria-Gasteiz 01009, Spain,
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Durán-Cantolla J, Alkhraisat MH, Martínez-Null C, Aguirre JJ, Guinea ER, Anitua E. Frequency of obstructive sleep apnea syndrome in dental patients with tooth wear. J Clin Sleep Med 2015; 11:445-50. [PMID: 25665693 DOI: 10.5664/jcsm.4602] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/12/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To estimate the frequency of obstructive sleep apnea syndrome (OSAS) in dental patients with tooth wear, and to assess the role of dentists in the identification of patients at risk of OSAS. METHODS Dental patients with tooth wear and treated with occlusal splint were prospectively recruited to perform sleep study. The severity of tooth wear was established by the treating dentist before patient referral to sleep disorders unit. Sleep questionnaires, anthropometric measurements, and validated respiratory polygraphy were performed. RESULTS All patients with dental wear were offered a sleepiness analysis. Of 31 recruited patients, 30 (77% males) participated in this study. Patients' mean age was 58.5 ± 10.7 years (range: 35-90 years) and the body mass index was 27.9 ± 3.4 kg/m(2). Tooth wear was mild in 13 patients, moderate in 8 and severe in 9. The mean apnea-hypopnea index (AHI) was 32.4 ± 24.9. AHI < 5 was reported in 2 patients, AHI of 5-29 in 17, and AHI ≥ 30 in 11. A statistically significant association was found between AHI severity and tooth wear severity (Spearman R = 0.505; p = 0.004). CONCLUSIONS Tooth wear could be a tool to identify those patients at risk of having OSAS. This highlights the importance of dental professionals to identify and refer patients with OSAS.
Collapse
Affiliation(s)
- Joaquín Durán-Cantolla
- Sleep Disorders Unit, Clínica Eduardo Anitua, Vitoria, Spain.,Sleep Disorders Unit, Hospital Universitario Araba, Vitoria, Spain.,Research Service, BioAraba Project, Hospital Universitario Araba, Vitoria, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, (CIBERES), ISCIII, Madrid, Spain.,Faculty of Medicine, University of País Vasco UPV/EHU, Biscay, Spain
| | | | - Cristina Martínez-Null
- Sleep Disorders Unit, Clínica Eduardo Anitua, Vitoria, Spain.,Sleep Disorders Unit, Hospital Universitario Araba, Vitoria, Spain.,Research Service, BioAraba Project, Hospital Universitario Araba, Vitoria, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, (CIBERES), ISCIII, Madrid, Spain
| | | | | | - Eduardo Anitua
- Sleep Disorders Unit, Clínica Eduardo Anitua, Vitoria, Spain.,Eduardo Anitua Foundation, Vitoria, Spain
| |
Collapse
|
8
|
Ferré A, Vila J, Arcalís N. [Usefulness of the basic exploration of the upper airways and neighbor structures in patients with adult obstructive sleep apnea-hypopnea syndrome]. Med Clin (Barc) 2014; 142:310-6. [PMID: 23830550 DOI: 10.1016/j.medcli.2013.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/11/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a prevalent disease in the general population, associated with an increase in the cardiovascular morbimortality. A basic and/or standardized otolaryngologic exploration could help us to detect the structural abnormalities that alter the upper airway collapsibility and offer a high pre-test risk factor, improve the CPAP adherence or even the possibility of offering alternative treatments. This article offers a revision of the exploration in OSAHS patients. We describe a guideline to identify the main structural abnormalities related to OSAHS. We also include a short algorithm for the diagnosis of OSAHS, when is suspected by primary care physicians.
Collapse
Affiliation(s)
- Alex Ferré
- Unidad Multidisciplinar del Sueño, Hospital Universitario Vall d'Hebrón, Barcelona, España; Servicio de Neurofisiología Clínica, Hospital Universitario Vall d'Hebrón, Barcelona, España.
| | - Javier Vila
- Unidad Multidisciplinar del Sueño, Hospital Universitario Vall d'Hebrón, Barcelona, España; Servicio de Otorrinolaringología, Hospital Universitario Vall d'Hebrón, Barcelona, España
| | - Núria Arcalís
- Servicio de Radiología, Fundació Hospital de Mollet, Universidad Autónoma de Barcelona, Barcelona, España
| |
Collapse
|
9
|
Isetta V, León C, Torres M, Embid C, Roca J, Navajas D, Farré R, Montserrat JM. Telemedicine-based approach for obstructive sleep apnea management: building evidence. Interact J Med Res 2014; 3:e6. [PMID: 24554392 PMCID: PMC3961625 DOI: 10.2196/ijmr.3060] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/17/2014] [Accepted: 01/19/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Telemedicine seems to offer reliable solutions to health care challenges, but significant contradictory results were recently found. Therefore, it is crucial to carefully select outcomes and target patients who may take advantage of this technology. Continuous positive airway pressure (CPAP) therapy compliance is essential to treat patients with obstructive sleep apnea (OSA). We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management. OBJECTIVE The objective of our study was to evaluate the application of a telemedicine-based approach in the CPAP therapy management, focusing on patients' CPAP follow-up and training. METHODS We performed two studies. First, (study 1) we enrolled 50 consecutive OSA patients who came to our sleep center for the CPAP follow-up visit. Patients performed a teleconsultation with a physician, and once finalized, they were asked to answer anonymously to a questionnaire regarding their opinion about the teleconsultation. In a second randomized controlled trial (RCT) (study 2), we included 40 OSA patients scheduled for CPAP training. There were 20 that received the usual face-to-face training and 20 that received the training via videoconference. After the session, they were blindly evaluated on what they learned about OSA and mask placement. RESULTS More than 95% (49/50) of the interviewed patients were satisfied with the teleconsultation, and 66% (33/50) of them answered that the teleconsultation could replace 50%-100% of their CPAP follow-up visits. Regarding the RCT, patients who received the CPAP training via videoconference demonstrated the same knowledge about OSA and CPAP therapy as the face-to-face group (mean 93.6% of correct answers vs mean 92.1%; P=.935). Performance on practical skills (mask and headgear placement, leaks avoidance) was also similar between the two groups. CONCLUSIONS OSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training. These results support the use of this telemedicine-based approach as a valuable strategy for patients' CPAP training and clinical follow-up.
Collapse
Affiliation(s)
- Valentina Isetta
- Unit of Biophysics and Bioengineering, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Mesquita J, Fiz JA, Sola-Soler J, Morera J, Jane R. Regular and non regular snore features as markers of SAHS. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2011; 2010:6138-41. [PMID: 21097143 DOI: 10.1109/iembs.2010.5627786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sleep Apnea-Hypopnea Syndrome (SAHS) diagnosis is still done with an overnight multi-channel polysomnography. Several efforts are being made to study profoundly the snore mechanism and discover how it can provide an opportunity to diagnose the disease. This work introduces the concept of regular snores, defined as the ones produced in consecutive respiratory cycles, since they are produced in a regular way, without interruptions. We applied 2 thresholds (TH(adaptive) and TH(median)) to the time interval between successive snores of 34 subjects in order to select regular snores from the whole all-night snore sequence. Afterwards, we studied the effectiveness that parameters, such as time interval between successive snores and the mean intensity of snores, have on distinguishing between different levels of SAHS severity (AHI (Apnea-Hypopnea Index) < 5h(-1), AHI <10 h(-1), AHI < 15 h(-1), AHI < 30 h(-1)). Results showed that TH(adaptive) outperformed TH(median) on selecting regular snores. Moreover, the outcome achieved with non-regular snores intensity features suggests that these carry key information on SAHS severity.
Collapse
Affiliation(s)
- J Mesquita
- Dept. ESAII, Universitat Politècnica de Catalunya (UPC), Institut de Bioenginyeria de Catalunya (IBEC), Barcelona, Spain.
| | | | | | | | | |
Collapse
|