Polisomnografí A Dinamica No Dise.: Club de Revistas Julián David Cáceres O. Otorrinolaringología
Polisomnografí A Dinamica No Dise.: Club de Revistas Julián David Cáceres O. Otorrinolaringología
Polisomnografí A Dinamica No Dise.: Club de Revistas Julián David Cáceres O. Otorrinolaringología
A DINAMICA NO
DISE.
CLUB DE REVISTAS
JULIÁN DAVID CÁCERES O.
OTORRINOLARINGOLOGÍA
Las pruebas de sueño que utilizan dispositivos portátiles de nivel 3
pueden acelerar el diagnóstico y reducir los costos asociados con la
polisomnografía en laboratorio de nivel 1. Intentamos evaluar la
precisión diagnóstica de las pruebas de nivel 3 en comparación con las
pruebas de nivel 1 e identificar la población de pacientes adecuada para
cada prueba.
PACIENTES
Edad media de 50,8 años.
Puntuación media de 11,6 en la escala de Epworth Sleepines
IMC medio de 30,4.
Proporción de pacientes masculinos y femeninos fue de 2,9 a 1.
Se notificaron 1382 comorbilidades:
Enfermedades cardiovasculares las más comunes (1080 pacientes, 78,1% de las comorbilidades
totales).
Hipertension arterial (574 pacientes)
Enfermedad cardíaca crónica estable (142 pacientes)
Enfermedad arterial coronaria (113 pacientes).
1 Paciente con asma y 9 pacientes con enfermedad pulmonar obstructiva crónica (0,7% de las
comorbilidades totales).
Technical failures affected 0.44% of patients who underwent level 1 tests,
1.30% of patients who underwent in-laboratory level 3 tests and 10.25%
of patients who underwent level 3 tests at home.
CONCLUSIONES
Our findings confirm that level 3 devices are useful in the diagnosis of obstructive sleep apnea in patients with a
high pretest likelihood of having moderate to severe forms of the condition.
The American Academy of Sleep Medicine and Canadian Sleep Society/Canadian Thoracic Society guidelines
recommend that portable sleep studies be provided under the direction of health professionals with accreditation in
sleep medicine and as part of a comprehensive assessment.
The US Centers for Medicare & Medicaid Services has determined that portable devices (with a minimum of 3
channels) are acceptable for diagnosing obstructive sleep apnea in patients with clinical signs or symptoms
suggestive of the condition.
Obstructive sleep apnea (OSA) affects 1-5% of
pediatric patients. Laborator polysomnography is
expensive, not always available, and is inconvenient
for patients. Our study investigates the diagnostic
ability of an unattended ambulatory monitor for the
diagnosis of pediatric OSA.
METHODS
Our results in a small population found that the portable device did not perform well
compared to the PSG in calculating the AHI and LSAT, or in accurately diagnosing OSA.
However, we did find that the results from the home sleep test were reproducible over
multiple nights of use.
The results compared significantly better in children age 6 and over, suggesting that older
children may be better suited for home sleep apnea testing.
Additional studies on larger numbers of patients will be needed prior to widespread use of
home sleep apnea testing in children.
Test the utility of an integrated clinical pathway for
obstructive sleep apnea (OSA) diagnosis and
continuous positive airway pressure (CPAP) treatment
using portable monitoring devices
METHODS
DESIGN: Randomized, open-label, parallel group, unblinded, multicenter clinical trial comparing home-based,
unattended portable monitoring for diagnosis and autotitrating CPAP (autoPAP) compared with in-laboratory
polysomnography (PSG) and CPAP titration.
SETTING: Seven American Academy of Sleep Medicine (AASM) accredited sleep centers.
PARTICIPANTS: Consecutive new referrals, age 18 yr or older with high probability of moderate to severe OSA
(apnea-hypopnea index [AHI] ≥ 15) identified by clinical algorithm and Epworth Sleepiness Scale (ESS) score ≥
12.
INTERVENTIONS: Home-based level 3 testing followed by 1 wk of autoPAP with a fixed pressure CPAP
prescription based on the 90% pressure from autotitration of PAP therapy (autoPAP) device (HOME) compared
with attended, in-laboratory studies (LAB).
MEASUREMENTS: CPAP acceptance, time to treatment, adherence at 1 and 3 mo; changes in ESS, and
functional outcomes.
Functional Outcomes of Sleep Questionnaire (FOSQ),7 Medical Outcomes Study 36-Item Short Form (SF36),8 Calgary
Sleep Apnea Quality of Life Index (SAQLI),9 European Health Status Questionnaire (EQ-5D) center for Epidemiologic
Studies Depression scale (CESD-10).
INCLUSION - EXCLUSION