Resources and Delays in the Diagnosis of Sleep Apnea-Hypopnea Syndrome

Jiménez, Juan Fernando Masa; Illa, Ferran Barbé; Gil, Francisco Capote; Vives, Eusebio Chiner; de Ataur, Josefa Díaz; Cantoll, Joaquín Durán; Ortiz, Salvador López; Trigo, José María Marín; Canal, José María Montserrat; González, Manuela Rubio; Santos, Joaquín Terán; Sanz, Carlos Zamarrón; for the Working Group

doi:10.1016/S1579-2129(07)60050-0

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

It is a monthly journal in which all manuscripts are sent to peer-review and handled by the editor or an associate editor from the team and the final decision is made on the basis of the comments from the expert reviewers and the editors. The journal is published solely in English. All the published data is composed of novel manuscripts not previously published in any other journal and not being in consideration for publication in any other journal..

The journal is indexed at Science Citation Index Expanded, Medline/Pubmed, Embase and SCOPUS. Access to any published article is possible through the journal's web page as well as from Pubmed, ScienceDirect, and other international databases. Furthermore, the journal is also present in X, Facebook and Linkedin. Manuscripts can be submitted electronically using the following web site: https://www.editorialmanager.com/ARBR/.

Indexed in:

Current Contents/Clinical Medicine, JCR SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, SCOPUS, IBECS

Subscribe:

Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

8.7

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.5

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.464

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.482

View more metrics

Open Access Option

Journal Information

Previous article | Next article

Vol. 43. Issue 4.

Pages 188-198 (April 2007)

More article options

Pages 188-198 (April 2007)

Original Articles

DOI: 10.1016/S1579-2129(07)60050-0

Full text access

Resources and Delays in the Diagnosis of Sleep Apnea-Hypopnea Syndrome

Visits

4670

Download PDF

Juan Fernando Masa Jiméneza,

Corresponding author

fmasa@separ.es

Correspondence: Dr. J.F. Masa Jiménez. Hospital San Pedro de Alcántara. Avda. Pablo Naranjo, s/n. 10004 Cáceres. España

, Ferran Barbé Illab, Francisco Capote Gilc, Eusebio Chiner Vivesd, Josefa Díaz de Ataure, Joaquín Durán Cantolla,f, Salvador López Ortizg, José María Marín Trigoh, José María Montserrat Canali, Manuela Rubio Gonzálezj, Joaquín Terán Santosk, Carlos Zamarrón Sanzl, for the Working Group1

a Sección de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain

b Servicio de Neumología, Hospital Arnau de Vilanova, Lérida, Spain

c Servicio de Neumología, Hospital Virgen del Rocío, Sevilla, Spain

d Sección de Neumología, Hospital San Juan, Alicante, Spain

e Servicio de Neumología, Hospital 12 de Octubre, Madrid, Spain

f Sección de Neumología, Hospital Txagorritxu, Vitoria, Álava, Spain

g Servicio de Neumología, Hospital Virgen de las Nieves, Granada, Spain

h Servicio de Neumología, Hospital Miguel Servet, Zaragoza, Spain

i Servicio de Neumología, Hospital Clínic, Barcelona, Spain

j Atención Primaria, Centro de Salud San Jorge, Cáceres, Spain

k Sección de Neumología, Hospital General Yagüe, Burgos, Spain

l Servicio de Neumología, Hospital Clínico Universitario, Santiago de Compostela, La Coruña, Spain

This item has received

4670 Visits

Article information

Statistics

Objective

The demand for consultations and diagnostic studies for sleep apnea-hypopnea syndrome (SAHS) has increased, and this has led to considerable delays. We therefore need an updated evaluation of the diagnostic situation to serve as a management tool for specialists and health care administrations responsible for solving the problem. The objective of the present study was to carry out a descriptive analysis of the situation regarding the diagnosis of SAHS in Spanish hospitals.

Methods

We undertook a descriptive cross-sectional observational study. Public and private hospitals listed in the Ministry of Health's 2005 catalog of health care institutions were contacted, and those that routinely evaluate patients for SAHS were included in the study. The person in charge of each hospital filled in a questionnaire concerning the availability of resources and waiting periods for diagnosis.

Results

Of the 741 hospitals we contacted, 217 routinely evaluated patients for SAHS. In 88% of these, respiratory polygraphy (RP) (n=168) or polysomnography (PSG) (n=97) was available. The mean waiting period was 61 days for consultation and 224 days for RP. The mean number of RP devices was 0.99 per 100 000 inhabitants, while the recommended number is 3 per 100 000 inhabitants. The mean waiting period for PSG was 166 days. The mean number of PSG beds was 0.49 per 100 000 inhabitants, while the recommended number is 1 per 100 000.

Conclusions

We observed a marked inadequacy of resources that has led to unacceptable waiting periods. While there has been a favorable change in the situation regarding SAHS diagnosis compared to previous studies, there is still room for improvement and it is urgent that health care authorities allocate more resources to this public health problem.

Key words:

Sleep apnea

Respiratory Polygraphy

Polysomnography

Delays

Waiting lists

Objetivo

La demanda de consultas y estudios diagnósticos del síndrome de apneas-hipopneas durante el sueño (SAHS) se ha incrementado, lo que ha llevado a importantes demoras. Por tanto, es precisa una evaluación actualizada de la situación del diagnóstico que sirva como herramienta de gestión a especialistas y las administraciones sanitarias que tienen la responsabilidad de solventar el problema. El objetivo del presente estudio ha sido realizar un análisis descriptivo de la situación del diagnóstico del SAHS en los hospitales españoles.

Métodos

Se ha realizado un estudio descriptivo, observacional y transversal. Se estableció contacto con los centros públicos y privados incluidos en el catálogo de instituciones sanitarias del Ministerio de Sanidad de 2005. Se incluyeron aquellos que evaluaban habitualmente a pacientes con SAHS. El responsable de cada centro rellenó un cuestionario sobre disponibilidad de recursos y demoras para el diagnóstico.

Resultados

De los 741 centros con los que se estableció contacto, 217 evaluaban habitualmente a pacientes con SAHS. El 88% disponía de poligrafía respiratoria (PR) (n = 168) o polisomnografía (PSG) (n = 97). La demora media en consulta fue de 61 días, y la demora media para realizar PR, de 224 días. La media de equipos de PR fue de 0,99/100.000 habitantes, cuando lo recomendable es 3/100.000. La demora media para PSG fue de 166 días. La media de camas de PSG fue de 0,49/100.000 habitantes y lo recomendable es 1/100.000.

Conclusiones

Se observa una notable deficiencia de recursos que lleva a inaceptables listas de espera. Aunque la situación del diagnóstico de SAHS ha cambiado favorable-mente con respecto a estudios previos, sigue siendo mejorable y es imprescindible que las autoridades sanitarias dediquen más recursos a este problema de salud pública.

Palabras clave:

Apneas del sueño

Poligrafía respiratoria

Polisomnografía

Demoras

Lista de espera

Full text is only aviable in PDF

References

[1]

J Durán, N González Mangado, JM Marín, M Solans, C Zamarrón, JM Montserrat.

Concepto, definición y epidemiología.

Arch Bronconeumol, 38 (2002), pp. 3-9

[2]

A Jiménez, R Golpe.

Clínica del síndrome de apnea-hipopnea obstuctiva del sueño (SAOS).

Apneas e hipopneas durante el sueño: visión actual,

[3]

T Young, M Palta, J Dempsey, J Skatud, S Weber, S Badr.

The occurrence of sleep disorders breathing among middle aged adults.

N Engl J Med, 328 (1993), pp. 1230-1235

http://dx.doi.org/10.1056/NEJM199304293281704 | Medline

[4]

J Durán, S Esnaola, R Ramón, A Iztueta.

Obstructive sleep apneahypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 years.

Am J Respir Crit Care Med, 163 (2001), pp. 685-689

http://dx.doi.org/10.1164/ajrccm.163.3.2005065 | Medline

[5]

PE Peppard, T Young, M Palta, J Skatrud.

Prospective study of the association between sleep-disordered breathing and hypertension.

N Engl J Med, 342 (2000), pp. 1378-1384

http://dx.doi.org/10.1056/NEJM200005113421901 | Medline

[6]

FJ Nieto, TB Young, BK Lind, E Shahar, JM Samet, S Redline, et al.

Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Hearth Health Study.

JAMA, 283 (2000), pp. 1829-1836

Medline

[7]

HF Becker, A Jerrentrup, T Ploch, L Grote, T Penzel, CE Sullivan, et al.

Effect of nasal continuous positive pressure treatment on blood pressure in patients with obstructive sleep apnea.

Circulation, 107 (2003), pp. 68-73

Medline

[8]

JC Pepperell, S Ramdassingh-Dow, N Crosthwaite, R Mullins, C Jenkinson, JR Stradling, et al.

Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial.

Lancet, 359 (2002), pp. 204-210

http://dx.doi.org/10.1016/S0140-6736(02)07445-7 | Medline

[9]

JF Masa, M Rubio, P Pérez, M Mota, J Sánchez de Cos, JM Montserrat.

Association between habitual naps and sleep apnea.

Sleep, 29 (2006), pp. 1463-1468

Medline

[10]

Y Peker, J Hedner, J Norum, H Kraiczi, J Carlson.

Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up.

Am J Respir Crit Care Med, 166 (2002), pp. 159-165

http://dx.doi.org/10.1164/rccm.2105124 | Medline

[11]

O Parra, A Arboix, S Bechich, L García-Eroles, JM Montserrat, JA López, et al.

Time course of sleep-related breathing disorders in first-ever stroke or transient ischemic attack.

Am J Respir Crit Care Med, 161 (2000), pp. 375-380

http://dx.doi.org/10.1164/ajrccm.161.2.9903139 | Medline

[12]

HK Yaggi, J Concato, WN Kernan, JH Lichtman, LH Brass, V Mohsenin.

Obstructive sleep apnea as a risk factor for stroke and death.

N Engl J Med, 353 (2005), pp. 2034-2041

http://dx.doi.org/10.1056/NEJMoa043104 | Medline

[13]

JM Marín, SJ Carrizo, E Vicente, A Agustí.

Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study.

Lancet, 365 (2005), pp. 1046-1053

http://dx.doi.org/10.1016/S0140-6736(05)71141-7 | Medline

[14]

J Terán-Santos, A Jiménez-Gómez, J Cordero-Guevara, the Cooperative Group Burgos-Santander.

The association between sleep apnea and the risk of traffic accidents.

N Engl J Med, 340 (1999), pp. 847-851

http://dx.doi.org/10.1056/NEJM199903183401104 | Medline

[15]

F Barbé, J Pericás, A Muñoz, LJ Findley, JM Antó, AGN Agustí.

Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study.

Am J Respir Crit Care Med, 158 (1998), pp. 18-22

http://dx.doi.org/10.1164/ajrccm.158.1.9709135 | Medline

[16]

JF Masa, M Rubio, LJ Findley, JA Riesco, A Sojo, C Disdier.

Los conductores somnolientos tienen alta frecuencia de accidentes de tráfico asociados a exceso de RERAS (respiratory effort-related arousal).

Arch Bronconeumol, 39 (2003), pp. 153-158

Medline

[17]

JF Masa, M Rubio, LJ Findley, the Cooperative Group.

Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep.

Am J Respir Crit Care Med, 162 (2000), pp. 1407-1412

http://dx.doi.org/10.1164/ajrccm.162.4.9907019 | Medline

[18]

American Sleep Disorders Association.

Practice parameters for the indications for polysomnography and related procedures.

Sleep, 20 (1997), pp. 406-422

Medline

[19]

F Barbé, J Amilibia, F Capote, J Durán, N González-Mangado, A Jiménez, 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

Medline

[20]

WW Flemons, MR Littner, JA Rowley, P Gay, WM Anderson, DW Hudgel, et al.

Home diagnosis of sleep apnea: a systematic review of the literature.

Chest, 124 (2003), pp. 1543-1579

Medline

[21]

American Thoracic Society.

Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes.

Am J Crit Care Med, 150 (1994), pp. 1738-1745

[22]

JM Montserrat, J Amilibia, F Barbé, F Capote, J Durán, NG Mangado, et al.

Grupo de Trabajo del Área de Insuficiencia Respiratoria y Trastornos del Sueño. Tratamiento del síndrome de las apneashipopneas durante el sueño.

Arch Bronconeumol, 34 (1998), pp. 204-206

Medline

[23]

C Jenkinson, RJO Davies, R Mullins, JR Stradling.

Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomized prospective parallel trial.

Lancet, 353 (1999), pp. 2100-2105

http://dx.doi.org/10.1016/S0140-6736(98)10532-9 | Medline

[24]

E Ballester, JR Badia, L Hernández, E Carrasco, J De Pablo, C Fornas, et al.

Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome.

Am J Respir Crit Care Med, 159 (1999), pp. 495-501

http://dx.doi.org/10.1164/ajrccm.159.2.9804061 | Medline

[25]

HM Engleman, SE Martin, RN Kingshott, TW Mackay, IJ Deary, NJ Douglas.

Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome.

Thorax, 53 (1998), pp. 341-345

Medline

[26]

A Muñoz, LR Mayorales, F Barbé, J Pericás, AGN Agustí.

Long term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome.

Eur Respir J, 15 (2000), pp. 676-681

Medline

[27]

JF Masa, A Jiménez, J Durán, F Capote, C Monasterio, M Mayos, et al.

Alternative methods of titrating continuous positive airway pressure.

Am J Respir Crit Care Med, 170 (2004), pp. 1218-1224

http://dx.doi.org/10.1164/rccm.200312-1787OC | Medline

[28]

J Durán Cantolla, J Mar, G De la Torre Muñecas, R Rubio Aramendi, L Guerra.

El síndrome de apneas-hipopneas durante el sueño en España. Disponibilidad de recursos para su diagnóstico y tratamiento en los hospitales del Estado español.

Arch Bronconeumol, 40 (2004), pp. 259-267

Medline

[29]

J Durán Cantolla, J Amilibia Alonso, F Barbé Illá, F Capote Gil, N González Mangado, A Jiménez Gómez, et al.

Grupo de Trabajo de Área de Insuficiencia Respiratoria y Trastornos del Sueño. 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

Medline

[30]

J Terán Santos, C Fernández García, J Cordero Guevara.

Situación en España de los recursos diagnósticos y de los tratamientos con presión positiva continua sobre la vía aérea, en el síndrome de apneas-hipopneas obstructivas del sueño.

Arch Bronconeumol, 36 (2000), pp. 494-499

Medline

[31]

JF Masa, JM Montserrat, J Durán, the Spanish Group of Breathing and Sleep Disorders.

Diagnostic access for sleep apnea in Spain.

Am J Respir Crit Care Med, 170 (2004), pp. 195

http://dx.doi.org/10.1164/ajrccm.170.2.950 | Medline

[32]

EA Philipson.

Sleep apnea. A major public health problem.

N Engl J Med, 328 (1993), pp. 1271-1273

http://dx.doi.org/10.1056/NEJM199304293281712 | Medline