[Management of Adult Obstructive Sleep Apnea Syndrome in General Practice: a new model of risk prevention]
DOI:
https://doi.org/10.7175/cmi.v11i1.1291Keywords:
General Practitioners, Sleep Apnea, Obstructive, 4Q ModelAbstract
Obstructive Sleep Apnea Syndrome is a condition characterized by paused breathing during sleep due to complete or partial obstruction of the upper airways. It is still underdiagnosed and underestimated, despite its respiratory, cardiovascular, and neurocognitive complications. Polysomnography is the gold standard for diagnosis. The treatment protocol, that has to be agreed with the patient, is behavioral, ventilator, and sometimes surgical.
The role of general practitioners is essential for early identification of patients with high probability of OSAS. Physicians are supported by specific instruments of general practice, such as continuity of care, computerized medical records for oriented problems, medical history, and diagnostic-therapeutic methodology for an exclusive management model. Among their duties, there is also the management of care priorities for patients’ comorbidities.
References
World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases. A comprehensive approach. 2007. Disponibile all’indirizzo http://www.who.int/gard/publications/GARD%20Book%202007.pdf (ultimo accesso marzo 2017)
Altieri AM, Alma MG, Balbi B, et al; per conto di GARD-Italy. La formazione nell’ambito delle malattie respiratorie: il punto di vista del Medico di Medicina Generale. 2013. Disponibile all’indirizzo http://www.salute.gov.it/imgs/C_17_pubblicazioni_1891_allegato.pdf (ultimo accesso marzo 2017)
Bettoncelli G, Blasi F, Brusasco V, et al. The clinical and integrated management of COPD. Sarcoidosis Vasc Diffuse Lung Dis 2014; 31 Suppl 1: 3-21
Presidenza del Consiglio dei Ministri. Conferenza permanente per i rapporti tra lo stato, le regioni, e le province autonome di Trento e di Bolzano. Disponibile all’indirizzo http://www.statoregioni.it/Documenti/DOC_044351_82%20CSR%20PUNTO%20%2016%20ODG.pdf (ultimo accesso marzo 2017)
White DP, Younes MK. Obstructive sleep apnea. Compr Physiol 2012; 2: 2541-94; https://doi.org/10.1002/cphy.c110064; https://doi.org/10.1002/9781118704493.ch7
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002; 165: 1217-39; https://doi.org/10.1164/rccm.2109080
Simms T, Brijbassi M, Montemurro LT, et al. Differential timing of arousals in obstructive and central sleep apnea in patients with heart failure. J Clin Sleep Med 2013; 9: 773-9; https://doi.org/10.5664/jcsm.2918
Martin SE, Engleman HM, Deary IJ, et al. The effect of sleep fragmentation on daytime function. Am J Respir Crit Care Med 1996; 153 (4 Pt 1): 1328-32; https://doi.org/10.1164/ajrccm.153.4.8616562
Patrizia Scavalli. Requisiti psicofisici per la patente. Forlì (FC): EGAF edizioni, 2013
Sanna A. Obstructive sleep apnoea, motor vehicle accidents, and work performance. Chron Respir Dis 2013; 10: 29-33; https://doi.org/10.1177/1479972312473134
AAVV. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22: 667-89
Epstein LJ, Kristo D, Strollo PJ Jr, et al; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep M. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5: 263-76
Farre R, Hernandez L, Montserrat JM, et al. Sham continuous positive airway pressure for placebo-controlled studies in sleep apnoea. Lancet 1999; 353: 1154; https://doi.org/10.1016/S0140-6736(99)01056-9
Jenkinson C, Davies RJ, Mullins R, et al. Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 1999; 353: 2100-5; https://doi.org/10.1016/S0140-6736(98)10532-9
Bakker JP, Marshall NS. Flexible pressure delivery modification of continuous positive airway pressure for obstructive sleep apnea does not improve compliance with therapy: systematic review and meta-analysis. Chest 2011; 139: 1322-30; https://doi.org/10.1378/chest.10-2379
Orth MM, Grootoonk S, Duchna HW, et al. Short-term effects of oral theophylline in addition to CPAP in mild to moderate OSAS. Respir Med 2005; 99: 471-6; https://doi.org/10.1016/j.rmed.2004.09.010
Hoddes E, Zarcone V, Smythe H, et al. Quantification of sleepiness: a new approach. Psychophysiology 1973; 10: 431-6; https://doi.org/10.1111/j.1469-8986.1973.tb00801.x
The Epworth Sleepiness Scale. The official website. http://epworthsleepinessscale.com (ultimo accesso marzo 2017)
Bettoncelli G, Monti GC, Paolini I. Analisi 4Q. Analisi diagnostica a 4 quadranti. Rivista della Società Italiana di Medicina Generale 2009; 3: 42-3
Luft J. Introduction à la dynamique des groups. Toulouse: Éditions Privat, 1968
Cogliani E, Wilber K. Una sintesi del pensiero. Milano: Alba Magica Edizioni, 2005
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