Journal Information
Vol. 40. Issue 6.
Pages 259-267 (June 2004)
Share
Share
Download PDF
More article options
Vol. 40. Issue 6.
Pages 259-267 (June 2004)
Original Articles
Full text access
The Availability in Spanish Public Hospitals of Resources for Diagnosing and Treating Sleep Apnea-Hypopnea Syndrome
Visits
3756
J. Durán-Cantollaa,
Corresponding author
joaquin.duran@wanadoo.es

Correspondence: Dr. J. Durán-Cantolla. Unidad Respiratoria de Trastornos del Sueño. Hospital Txagorritxu. José Achotegui, s/n. 01009 Vitoria. España
, J. Marb, G. de la Torre Muñecasa, R. Rubio Aramendia, L. Guerraa
a Unidad Respiratoria de Trastornos del Sueño, Hospital Txagorritxu, Vitoria, Spain
b Unidad de Gestión Sanitaria, Hospital Alto Deba, Mondragón, Guipúzcoa, Spain
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Introduction and Objective

Sleep apnea-hypopnea syndrome is associated with an overall deterioration in the patient's health and affects between 1 and 2 million people in Spain. The objective of the present study was to evaluate the diagnostic and therapeutic resources available in Spain for dealing with this problem in terms of both infrastructure and human resources.

Methods

We selected 461 general hospitals, 457 (99.1%) of which answered a questionnaire in the course of a telephone interview.

Results

At the time of response, 219 hospitals (47.5%) reported performing sleep studies. Conventional polysomnography was available in 53% of those hospitals, respiratory polygraphy was used in 42%, and oximetry in 5%. In 47% of the hospitals, continuous positive airway pressure was titrated empirically in most cases; the number of patients being treated with CPAP was 109 752, that is, 269 per 100 000 population in Spain.

Conclusions

The level of resources available for diagnosing and treating sleep apnea-hypopnea syndrome, although improving, is clearly still inadequate. Currently, only 0.49 polysomnograph and 0.72 polygraph machines are available per 100 000 population, whereas 1 and 3 machines, respectively, are deemed necessary. Only 5% to 10% of the affected population has been diagnosed, and in 47% of the hospitals interviewed continuous positive airway pressure is not properly titrated. These results should be a clarion call to the health authorities to take the appropriate steps to address this health problem.

Key words:
Sleep apnea-hypopnea syndrome (SAHS)
Continuous positive airway pressure (CPAP)
Diagnosis
Treatment
Conventional nocturnal polysomnography (PSG)
Respiratory polygraphy (RP)
General population
Patients
Introducción y Objetivo

El síndrome de apneas-hipopneas durante el sueño está asociado a un deterioro del estado de salud y constituye un problema sanitario que en España sufren entre 1 y 2 millones de personas. El objetivo del estudio fue evaluar cuáles son los medios diagnósticos y terapéuticos disponibles en España, tanto en infraestructu-ras como en recursos humanos, para abordar este problema.

Métodos

Se seleccionaron 461 hospitales generales y me-diante contacto telefónico se administró un cuestionario a 457 (99,1%).

Resultados

Realizan estudios de sueño 219 centros (47,5%). El 53% dispone de polisomnografía convencional, un 42% emplea la poligrafía respiratoria y un 5% la oximetría. Un 47% de los centros realiza titulaciones de presión positiva continua de la vía aérea de forma mayoritariamente empírica y existen en activo 109.752 aparatos, lo que representa 269 equipos por 100.000 habitantes.

Conclusions

El nivel de recursos para el diagnóstico y el tratamiento del síndrome de apneas-hipopneas durante el sueño, a pesar de haber mejorado, es claramente insuficiente. Son necesarios un polisomnógrafo convencional y 3 polí-grafos, mientras que actualmente se cuenta con 0,49 y 0,72 por 100.000 habitantes, respectivamente. Sólo se ha diagnos-ticado el 5-10% de la población afectada y en el 47% de los centros la presión positiva continua de la vía aérea se titula de forma inadecuada. Estos resultados deberían suponer una importante llamada de atención a las autoridades sanitarias para abordar apropiadamente este problema sanitario.

Palabras clave:
Síndrome de apneas-hipopneas durante el sueño (SAHS)
Presión positiva continua de la vía aérea (CPAP)
Diagnóstico
Tratamiento
Polisomnografía convencional nocturna
Full text is only aviable in PDF
REFERENCES
[1]
JM Montserrat, J Amilibia, F Barbé, F Capote, J Durán, NG Mangado, et al.
Tratamiento del síndrome de las apneas-hipopneas durante el sueño.
Arch Bronconeumol, 34 (1998), pp. 204-206
[2]
American Academy of Sleep Medicine Task Force.
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research.
Sleep, 22 (1999), pp. 667-689
[3]
T Young, M Palta, J Dempsey, et al.
The occurrence of sleep disorded breathing among middle-aged adults.
N Engl J Med, 328 (1993), pp. 1230-1236
[4]
J Durán, S Esnaola, R Ramón, A Iztueta.
Obstructive sleep apnea-hypopnea 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
[5]
JM Marin, JM Gascón, S Carrizo, JA Gispert.
Prevalence of sleep apnoea in the Spanish adult population.
Intern J Epidemiol, 26 (1977), pp. 381-386
[6]
C Zamarrón, F Gude, Y Otero, JM Álvarez, A Golpe, JR Rodríguez.
Prevalence of sleep disordered breathing and sleep apnea in 50 to 70 year old individuals. A survey.
Respiration, 66 (1999), pp. 317-322
[7]
CM Baldwin, KA Griffith, FJ Nieto, GT O´Connor, JA Walsleben, S Redline.
The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study.
Sleep, 24 (2001), pp. 96-105
[8]
EO Bixler, AN Vgonzas, HM Lin, TT Have, BE Leib, A Vela-Bueno, et al.
Association of hypertension and sleep-disordered breathing.
Arch Intern Med, 160 (2000), pp. 2289-2295
[9]
T Young, P Peppard, M Palta, KM Hla, L Finn, B Morgan, et al.
Population-based study of sleep-disordered breathing as a risk factor for hypertension.
Arch Intern Med, 157 (1997), pp. 1746-1752
[10]
P Lavie, P Herer, V Hofstein.
Obstructive sleep apnea syndrome as a risk factor for hypertension: population study.
BMJ, 320 (2000), pp. 479-482
[11]
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
[12]
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 Heart Health Study.
JAMA, 283 (2000), pp. 1829-1836
[13]
E Shahar, CW Whitney, S Redline, ET Lee, AB Newman, FJ Nieto, et al.
Sleep-disordered breathing and cardiovascular disease.
Cross-sectional results of the Sleep Heart Health Study Am J Respir Crit Care Med, 163 (2001), pp. 19-25
[14]
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 Crit Care Med, 166 (2002), pp. 159-165
[15]
C Bassetti, MS Aldrich.
Sleep apnea in acute cerebrovascular disease: final report on 128 patients.
Sleep, 22 (1999), pp. 217-223
[16]
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
[17]
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
[18]
F Barbé, J Pericás, A Muñoz, L 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
[19]
J He, MH Kryger, FJ Zorick, W Conway.
Mortality and apnea index in obstructive sleep apnea.
Chest, 94 (1988), pp. 9-14
[20]
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
[21]
J Mar, JR Rueda, J Durán-Cantolla, C Schechter, J Chilcott.
The cost-effectiveness of CPAP treatment in patients with moderate to severe obstructive sleep apnoea.
Eur Respir J, 21 (2003), pp. 515-522
[22]
EA Phillipson.
Sleep apnea. A major public health problem.
N Engl J Med, 328 (1993), pp. 1271-1273
[23]
MH Kryger, L Ross, K Delaive, R Walld, J Horrocks.
Utilization of health care services in patients with severe obstructive sleep apnea.
Sleep, 19 (1996), pp. S111-S1S6
[24]
J Ronald, K Delaive, L Roos, J Manfreda, A Bahammam, MH Kryger.
Health care utilization in the 10 years prior to diagnosis in obstructive sleep apnea patients.
Sleep, 2 (1999), pp. 225-229
[25]
T Gislason, B Benediktsdottir.
Snoring, apneic episodes, and nocturnal hypoxaemia among children 6 months to 6 years: an epidemiological study of lower limit of prevalence.
Chest, 107 (1995), pp. 963-966
[26]
L Brunetti, S Rana, ML Lospalluti, A Pietrafesa, R Francavilla, M Fanelli, et al.
Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southern Italy.
Chest, 120 (2001), pp. 1930-1935
[27]
A Sánchez-Armengol, MA Fuentes-Pradera, F Capote-Gil, E García-Díaz, S Cano-Gómez, C Carmona-Bernal, et al.
Sleep-related breathing disorders in adolescents aged 12 to 16 years. Clinical and polygraphic findings.
Chest, 119 (2001), pp. 1393-1400
[28]
EO Bixler, AN Vgontzas, TT Have, K Tyson, A Kales.
Effects of age on sleep apnea in men. I. Prevalence and severity.
Am J Respir Crit Care Med, 157 (1998), pp. 144-148
[29]
EO Bixler, AN Vgontzas, T Ten Have, HM Lin, TT Have, J Rein, et al.
Prevalence of sleep-disordered breathing in women. Effects of gender.
Am J Respir Crit Care Med, 163 (2001), pp. 608-613
[30]
S Ancoli-Israel, DF Kripke, MR Klauber, WJ Mason, R Fel, O Kaplan.
Sleep-disordered breathing in community-dwelling elderly.
Sleep, 14 (1991), pp. 486-495
[31]
J Durán, S Esnaola, R Rubio, G de la Torre, J Sollés, A Goicolea.
Obstructive sleep apnoea in the elderly. A population based-study in the general population aged 71-100.
Eur Respir J, 16 (2000), pp. 167
[32]
J Durán, J Amilibia, F Barbé, F Capote, N González-Mangado, A Jiménez, et al.
Disponibilidad de recursos técnicos para el diagnóstico y el tratamiento del síndrome de apneas obstructivas durante el sueño en los hospitales de laredpública del Estado.
Arch Bronconeumol, 31 (1995), pp. 463-469
[33]
J Terán, C Fernández, J Cordero.
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
[34]
Directorio Médico Sanitario 2002. Impar Edic. Prom SL y Menarini laboratorios, Madrid, 2002.
[35]
American Sleep Disorders Association.
Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association.
Sleep, 17 (1994), pp. 372-377
[36]
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 (SEPAR).Tratamiento del síndrome de las apneas-hipopneas durante el sueño.
Arch Bronconeumol, 34 (1998), pp. 204-206
[37]
F Capote, JF Masa, A Jiménez, G Peces-Barba, J Amilibia, R Rubio.
Manifestaciones clínicas del SAHS. Métodos diagnósticos. Síndrome de resistencia aumentada de la vía aérea superior.
Arch Bronconeumol, 38 (2002), pp. 21-27
[38]
JM Calleja, S Esnaola, R Rubio, J Durán.
Comparison of a cardiorespiratory device vs. polysomnography for diagnosis of sleep apnea.
Eur Respir J, 20 (2002), pp. 1-6
[39]
M Molina, L Hernandez, J Durán, R Farré, R Rubio, D Navajas, et al.
Protocolo para evaluar una CPAP automática. Valoración de la utilidad del Autoset-T para determiner la presión de CPAP óptima en el síndrome de apnea-hipopnea del sueño (SAHS).
Arch Bronconeumol, 39 (2003), pp. 118-125
Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

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