Abstract
INTRODUCTION: eventhough it is demonstrated that the treatment of sleep apnea syndrome improves mortality, morbility and quality of life of those patients, most of them are not diagnosed leading to a delayed therapeutic management.
OBJECTIVE: to measure the impact of the delay in the diagnosis of patients with obstructive sleep apnea syndrome on time and healthcare expenditures (medical visits and complementary tests).
METHODS: a multicenter descriptive study was conducted, at three Colombian health institutions. A survey asking about demographic, clinical and paraclinical aspects for the process of diagnosis was held.
RESULTS: total of 149 adult patients were followed. Patients had an average of 5,3 years of medical visits and complementary studies to obtain the diagnosis. The total cost in complementary tests was $841.677 per patient (2,2 monthly legal minimum salaries).
CONCLUSIONS: this results provide fairly clear medical and economic arguments in favour of early management of patients with obstructive sleep apnea syndrome, it is a frequent and poorly diagnosed and treated disease. General doctors and specialists must be trained to identify signs and symptoms to make the diagnosis (Acta Neurol Colomb 2006;22:12-24).
References
Baumel MJ, Maislin G, Pack AI. Population and occupational screening for obstructive sleep apnea: are we there yet? Am J Respir Crit Care Med 1997;155: 9-14.
Young T, Peppard PE y Gottlieb DJ. Epidemiology of Obstructive Sleep Apnea. A Population Health Perspective. Am J Respir Crit Care Med 2002;:1217-1239.
ICSD- International classification of sleep disorders: diagnostic and coding manual. Diagnostic Classification Steering Committee.American Sleep. Thorpy MJ, Chairman. American Sleep Disorders Association, 1990.
Flemons WW, Douglas NJ, Kuna ST, Rodenstein DO, Wheatley J. Access to Diagnosis and Treatment of Patients with Suspected Sleep Apnea. Am J Respir Crit Care Med 2004;169:668-672.
Pelletier-Fleury N, Gagbadoux F, Philippe C, Rakotonanahary D, Lanoe JL, Fleury B. A cost- minimization study of telemedicine. The case of telemonitored polysomnography to diagnose obstructive sleep apnea syndrome. Int J Technol Assess Health Care 2001;17(4):604-611.
Meslier N, Ouksel H, Racineux JL. Obstructive sleep apnea syndrome and cardiovascular risk. Rev Neurol (Paris) 2001;157(11 Pt 2):S42-45.
Meslier N, Lebrun T, Grillier-Lanoir V, Rolland N, Henderick C, Sailly JC, Racineux JL. A French survey of 3,225 patients treated with CPAP for obstructive sleep apnoea: benefits, tolerance, compliance and quality of life. Eur Respir J 1998;12(1):185-192.
Pelletier-Fleury N, Meslier N, Gagnadoux F, Person C, Rakotonanahary D, Ouksel H, Fleury B, Racineux JL. Economic arguments for the immediate management of moderate-to-severe obstructive sleep apnoea syndrome. Eur Respir J 2004;23:53-60.
American Academy of Sleep Medicine Task Force. Sleep related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999;22:667-687.
American Sleep Disorders Association. Practice parameters for the indications for polysomnography and related procedures. Sleep 1997;20:406-422.
Rechtschaffen A, KalesA. A manual of standardized terminology, techniques and scoring system for sleep stages for human subjects. Publication No.204. Bethesda, National Institutes of Health, 1968.
Baumel MJ, Maislin G, Pack AI. Population and occupational screening for obstructive sleep apnea: are we there yet? Am J Respir Crit Care Med 1997;155: 9-14.
Guilleminault C, Hoed J, Mitler MN. Clinical overview of the sleep apnea syndromes. En: Gulleminault C, Dement W, eds. Sleep apnea syndromes. New York: Liss, 1985:983-988.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-1235.
Culebras A. La Medicina del sueño. Barcelona: Ancora, 1994.
Kimura H, Talsumi K, Masuyama S, Kuriyama T. Diagnosis and treatment of sleep apnea syndrome in Japan comparison with other countries. Nippon-Kyobu-Shikkan- Gakkai-Zasshi 1995;33(Suppl):85-89.
Olson LG, King MT, Saunders NA, Hensley MJ. Emerging issues in sleep-disordered breathing. Med J Aust 1993;165:107-10.
Ross SD, Sheinhait IA, Harrison KJ, Kvasz M, Connelly JE, Shea SA, Allen IE. Systematic review and meta-analysis of the literature regarding the diagnosis of sleep apnea. Sleep 2000;24:1-14.
Morice A, Achio M. Tendencias, costos y desafíos para la atención de las enfermedades crónicas en Costa Rica. Rev cienc adm financ segur soc 2003;11: 18-34.
Flemons WW, McNicholas WT. Clinical prediction of the sleep apnea syndrome. Sleep Med Rev 1997;1:19-32.
Guilleminault C, Brooks SN. Excessive daytime sleepiness: a challenge for the practising neurologist. Brain 2001;124:1482-491.
Flemons WW. Obstructive sleep apnea. N Engl J Med 2002;347:498-504.
Wetter DW, Young TB, Bidwell TR, Badr MS, Palta M. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994;154:2219-2224.
Scanlan MF, Roebuck T, Little PJ, Redman JR, Naughton MT. Effect of moderate alcohol upon obstructive sleep apnoea. Eur Resp J 2000;16:909-913.
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 2000;284:3015-3021.
Weiss JW, Remsburg S, Garpestad E, Ringler J, Sparrow D, Parker JA. Hemodynamic consequences of obstructive sleep apnea. Sleep 1996;19(5):388-397.
Strollo PJ Jr, Rogers RM. Obstructive sleep apnea.
N Engl J Med 1996;334:99-104.
Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle aged men and women. Sleep 1997;9:705-706.
White J, Cates C, Wright J. Continuous positive airways pressure for obstructive sleep apnoea (Cochrane Review). In: The Cochrane Library, Issue 2, 2005. Oxford: Update Software.
Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT. Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med 2003;163(5):565-571.
Kryger MH, Roos L, Delaive K, Wallad R, Horrocks J. Utilization of health services in patients with severe obstructive sleep apnea. Sleep 1996;19:S111-S116.
Kapur V, Blough DK, Sandblom RE, Hert R, de Maine JB, Sullivan SD, Psaty BM. The medical cost of undiagnosed sleep apnoea. Sleep 1999;22:749-755.
Ohayon MM, Guilleminault C, Priest RG, Caulet M. Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom population sample. BMJ 1997;314:860-863.
Otake K, Delaive K, Walld R, Manfreda J, Kryger MH. Cardiovascular medication use in patients with undiagnosed obstructive sleep apnoea. Thorax 2002;57:417-22.
Bahammam A, Delaive K, Ronald J, Manfreda J, Roos L, Kryger MH. Healthcare utilization in males with obstructive sleep apnoea syndrome two years after diagnosis and treatment. Sleep 1999;22:740-747.
Findley LJ, Suratt PM. Serious motor vehicle crashes: the cost uf untreated sleep apnoea. Thorax 2001;56:505.
George CF. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax 2001;56:508-512.
Stepnowsky CJ, Berry C, Dimsdale JE. The effect of measurement unreliability on sleep and respiratory variables. Sleep 2004;27(5):990-995.
AASM Position Statement. Cost justification for diagnosis and treatment of obstructive sleep apnea. Sleep 2000;23(8):1-2.
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