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Documente Cultură
Un istoric amanuntit al
somnului este partea cea
mai fundamentala în
evaluarea subiecților cu
tulburări de somn.
Un istoric de somn
presupune evaluarea
ritmului somn/veghe pe o
perioada de 24 de ore.
Obtinerea unui istoric
colateral este adesea
elementar în identificarea
unui pacient cu tulburari
de somn.
Bibliografie
Chokroverty S. (2010). Overview of sleep & sleep disorders. Ind J Med Res; 131:
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of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax; 59: 618–622.
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obstructive sleep apnoea/hypopnoea syndrome. Thorax; 59: 347–352.
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Pagina 87 Diagnostic diferential
Puncte cheie
EDS este de obicei rezultatul
obiceiurilor nesanatoase de
viață asociate cu timp
insuficient de somn.
O evaluare corectă a EDS
necesită un istoric atent, de
preferință cu ajutorul unui
partener de somn.
Exista o corelatie slaba intre
somnolența subiectivă si testele
obiective ale somnolentei,
precum MSLT și MWT.
Puncte cheie
ESS este folosit pentrucuantificarea
subiectiva a somnolentei într-o gamă
desituații cotidiene, cu un scor total
>10 sugerând SDB.
Chestionarul Berlin arespecificitate
crescuta in vederea identificarii
subiecților cu OSAS moderat spre sever,
dar relativsensibilitate redusa.
Chestionarele STOP și STOP-Bang au
sensibilitate crescuta pentru
identificarea subiecților cu tulburari
respiratorii in somn, darspecificitate
relativ scăzută.
Calitatea somnului poate fi evaluat
subiectiv cu ajutorul PSQI.
Raspunsuri
Articolele 1, 4, 8, 10 Da (1), nu sau nu stiu (0)
Articolul 2 Puțin mai tare decât respirația (0)
La fel de tare ca vorbind (0)
Mai tare decât vorbind (1)
Poate fi auzit în cameră de langa (1)
Articolele 5, 6, 7, 9 Aproape în fiecare zi (1)
De 3–4 ori pe săptămână (1)
1–2 ori pe săptămână (0)
1–2 ori pe lună (0)
Niciodată (0)
Scoruri
Categoria 1 Pozitiv dacă scorul total >2puncte
Categoria 2 Pozitiv dacă scorul total >2puncte
Categoria 3 Pozitiv dacă răspunsul la articolul 10 este “da” sau
dacă IMC>30 kg/m2
Risc ridicat de OSAS: mai mult de 2categorii pozitive
Risc scăzut de OSAS: mai putin de 2categorii pozitive
Bibliografie
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(PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a
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apnea/hypopnea index. J Clin Sleep Med; 7: 459B–465B.
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index: the Sleep Heart Health Study
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daytime sleepiness: the Epworth sleepiness scale. Sleep; 14: 540–545. N Kapur VK,
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Pagina 95 Factori predispozanti
Puncte cheie
Cateva condiții predispun ladezvoltarea tulburarilor
respiratorii in somn.
Factori anatomici și funcționali sunt implicati in
patogeneza obstrucției căilor respiratorii superioare,
exclusiv sau înasociere cu alte condiții patologice.
Obezitatea este cel mai frecvent factor de risc întâlnit
la pacienții cu AOS,uneori asociat cu tulburări
endocrine.
De asemenea, alte boli predispun la SDB și ar trebui să
fie atentinvestigate în evaluarea clinicăa pacienților
cu suspiciune de OSA.
Insuficienta cardiacă cronică predispune la respiratie
Cheyne– Stokes în timpul somnului prin mecanisme
complexe ce implica controlul respiratiei de tip central
si periferic, dar este adesea asociată și cu apneea
obstructiva in somn.
Bibliografie
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Peppard PE, et al. (2007). Association of alcohol consumption and sleep disordered
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Schwab RJ, et al. (2003). Identification of upper airway anatomic risk factors for
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Algoritmi de diagnostic
Puncte cheie
De la polisomnografia de laborator
s-a ajuns la monitorizarea portabilă
la domiciliu în cazul pacienților cu
o probabilitate ridicată de OSAS.
Două grupe de pacienți Trebuie să fie
evaluati: 1) cei cu simptome; și 2)
cei cu factori de risc pentru OSAS.
O abordare de rețea este probabil
cel mai bun model de îngrijire pentru
gestionarea numarului crescut de
cazuri de afectiuni ale somnului.
Spital de referinta
Spital de non-referinta
Specialisti
Medicina de familie
Asistenti medicali
b)
Studiul
somnului
Figura 2. Cei trei pași care trebuie urmați întotdeauna atunci când este
suspectată apneea in somn: detectarea(pacienții care urmează a fi evaluați);
evaluarea clinică pentru diagnosticul diferențial și evaluareaseveritatii bolii;
si, în sfârșit, studiul somnului, care ar trebui efectuat pe baza unei
probabilitati de apnee in somn și prezența comorbiditatilor. AF-fibrilatie
atriala, RLS-sindromul picioarelor nelinistite, Hb- hemoglobină, RP- poligrafie
respiratorie
Tabelul 2. Entități de bază în OSAH
c)
Medici de familie sau alt
specialist
Suspiciune
Dispozitive simplificate
de SAHS
Medici de Element al somnului
familie sau Spital de non-referintă
alti RP
specialisti
Element al somnului
Spital de referintă
Echipă multidisciplinară
Echpament complet
Bibilografie
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