Apnea del Sueño y test de sueño Dr. Pedro Serrano MD, PhD, FESC 2008

Hoja de información para pacientes. Apnea del sueño Hoja de información para pacientes.

Posibles consecuencias de la apnea del sueño: Hipertensión arterial, infarto agudo de miocardio. Hipertensión pulmonar, insuficiencia cardiaca, disminución de capacidades mentales. Arritmias (ritmo cardiaco anormal), accidente cerebrovascular (embolias al cerebro). Accidentes de tráfico y en el trabajo, problemas sociales, depresión, impotencia.

Posibles consecuencias de la apnea del sueño: Horario nocturno Horario nocturno

Estudio del sueño nocturno o polisomnografía (1): Evaluación del sueño: calidad, despertares, convulsiones y alt. del movimiento: Actividad eléctrica cerebral (electroencefalograma: EEG). Movimiento de los ojos (electrooculograma: EOG). Actividad de los músculos (electromiograma: EM).

Estudio del sueño nocturno o polisomnografía (2): Evaluación del ritmo cardiaco con ECG. Evaluación de la respiración con: Pulsioximetría. Sensor de flujo aéreo en nariz y boca. Bandas torácica y abdominal para registrar los movimientos ventilatorios.

Estudio del sueño nocturno Electroencefalograma Electrooculograma Termistor +/- capnógrafo Electromiograma

Estudio del sueño nocturno Pulsioximetría

Estudio del sueño nocturno o polisomnografía (3): Además puede incluir: Micrófono para detectar ronquidos, Sensor de posición del cuerpo, Vídeo, Sensores de presión en la vía aérea o esófago…

Estudio del sueño nocturno Bandas torácica y abdominal Micrófono ECG

Enfermedades respiratorias del sueño Apnea del sueño: Obstructiva. Central. Mixta. Roncopatía. Hipopnea. Síndrome de resistencia elevada de las vías aéreas superiores. El 10% de la población está afectada!

Tratamiento de la apnea del sueño Cambios en la conducta habitual. Fármacos. Dispositivos para mantener abierta la vía aérea. C-PAP. Cirugía.

Estudio del sueño nocturno C-PAP / Bi-PAP

Cómo diagnosticar en su propia casa si tiene apnea del sueño. SleepStrip® Cómo diagnosticar en su propia casa si tiene apnea del sueño.

Pila miniatura de litio de 3V Sensor térmico para el flujo oral The SleepStrip Chip y electrónica 2 Sensores térmicos para el flujo nasal Luz indicadora Pila miniatura de litio de 3V Pantalla electro-química permanente Sensor térmico para el flujo oral

Instrucciones para usar SleepStrip

Cómo SleepStrip registra las apneas 100% X% T>10 sec. X <50% - hipopnea X <10% - Apnea The SleepStrip monitors the patient’s respiration by looking at the temperature of air near the nose and mouth. During inhalation the air is at room temperature, and during exhalation its at body temperature. This respiration sensing concept is used by most sleep labs. The signal is analyzed to measure its amplitude during the first few minutes after activation, before the patient fell asleep, so this part is still without apneas or hypopnea. This is the 100% respiration, and its updated through-out the night. All events are measured against this value. Hypopnea threshold was set at 50% of normal respiration, where the lab threshold is usually 30%. This was selected to compensate for lower sensitivity to hypopneas. This is needed since the SleepStrip doesn’t measure oxygen saturation or heart rate used by the technician in the lab to score hypopneas more accurately. The algorithm was refined by comparing the SleepStrip score to the lab score over hundreds of studies. Apnea = obstrucción completa del flujo durante >10 segundos. Hipopnea = Obstrucción parcial del flujo durante >10 segundos. IAH (Índice apnea/hipopnea) = promedio del nº de apneas/hipopneas por cada hora de sueño.

Cómo interpretar SleepStrip Sanos: Menos de 15 apneas-hipopneas por hora. Apnea ligera: 16 a 25 apneas-hipopneas por hora. Apnea moderada: 26 a 40 apneas-hipopneas por hora. Apnea severa: Más de 40 apneas-hipopneas por hora. Error: por estudio demasiado breve u otros problemas.

SleepStrip operation Must clean display before study for good readability Activated by attaching green sticker on display, light ON to mark proper activation During first 20 minutes, light flashes with each breath, normal respiration calibrated (assume patient still awake) After 20 minutes flashing stops and actual study begins (assume patient is already asleep) Must be on face at least 4.5 hours for a valid study When removed, long “apnea” signals end of study and light will turn ON After 30 minutes display can be read after removing the green sticker, do not remove sticker sooner

Estudio con SleepStrip Poner la etiqueta verde: se activa. Después de 20 min. se inicia el estudio automáticamente. Quitar la etiqueta verde y leer el resultado. Retirar de la cara First 20‘ measure normal flow At least 4 hours count apneas and hyponeas measure time Last 30’ Calculate AHI activate display Reading the SleepStrip display is very easy, just peel off the green sticker to read the number. It is better to do this as soon as possible, but not sooner than 1 hour after the study has ended. The display is permanent, and the device can be filed as the medical reference fro the study. If you are not sure the first time, you can always run a second study. Studies show that especially with mild cases there may be significant night to night variability of the same patient. This is especially true if the patient drinks, smokes or has trouble sleeping. AHI<15 15≤AHI<25 25≤AHI<40 40≤AHI Short study or low flow error

SleepStrip performance Location # of points SleepStrip Version Chief investigator Compare to Published in Correlation Threshold RDI Sensitivity Speci- ficity Paris France 20 4.1 Dr. P. Leger Inlab PSG Sleep 24/A294, 2001 0.91 (calculated from published data) 10 0.86 0.80 Marburg Germany 44 Dr. T. Penzel ERJ 19:121-126, 2002 0.85 0.91 Brussels Belgium 39 Dr. M. Kerkhofs ERJ 19: 121-126, 2002 0.81 0.88 0.67 4 labs in Israel 205 Dr. P. Lavie 0.7 0.87 0.52 Ulsan Korea Dr. J. Kim Poster, Korean Society of Otolaryngology meeting, 2001 No value given 0.75 Helsinki Finland 13 Dr. K. Hirvonen Poster at the Sleep Apnea meeting, Helsinki 2003 0.60 97 4.2 SLP Internal study, 2003 unpublished. N.A 15 0.83 0.69 The SleepStrip has been tested in several labs in Europe and Israel. Results are approximately similar in all studies. Differences can be attributed to different scoring criteria, different sensors and sleep monitoring systems, and different technicians scoring in the various labs. A nice point to notice is that correlation was best in Germany, and lowest in Israel at our own lab. This also shows that sleep lab AHI result is not an absolute value, but must be considered together with the clinical presentation and the specific condition of each patient. (1)”The SleepStripTM: an apnoea screener for the early detection of sleep apnoea syndrome” T. Shochat, N. Hadas, M. Kerkhofs, A. Herchuelz, T. Penze, J.H. Peter, P. Lavie. Eur Respir J 2002; 19: 121–126 (2) “Evaluation of the “SleepStrip", A Simple Device to Screen Apnea Patients in the General Population” , D. Leger, M. Elbaz, V. Stal(1), E. Frija, M. Cosquer, M. Paillard. Sleep 2001, 24,A294 (3) “Comparison and Analysis of Sleepstrip and polysomnography In patients with Obstructive Sleep Apnea Syndrome” , Jaeho Kim, Geunshik Yoo, Seunghyo Choi, Jongchan Kim Spring Meeting of the Korean Society of Otolaryngology 2001 (4) “The SleepStrip method as a screening tool for sleep apnea. “ Suvilehto J, Partinen M, Mikkola J, Penttilä M, Sumiala K, Hirvonen K. , 7th congress on sleep apnea, Helsinki 2003

SleepStrip accuracy Basic accuracy*1: For moderate SAS (indicated as at least mild SAS) >81% For Severe SAS (indicated as at least mild SAS) >98% Correlation with Sleep lab AHI score = 0.8 (valid studies) ROC AUC = 0.92 (AHI>40) *1 The SleepStripTM: an apnoea screener for the early detection of sleep apnoea syndrome T. Shochat*, N. Hadas*, M. Kerkhofs#, A. Herchuelz#, T. Penzel}, J.H. Peter}, P. Laviez Eur Respir J 2002; 19: 121–126