Access to diagnosis and treatment of patients with suspected sleep apnea
Access to diagnosis and treatment of patients with suspected sleep apnea
复制标题
DOI：
10.1164/rccm.200308-1124pp
复制
发表时间：
2004-03-15
影响因子：
24.7
通讯作者：
Wheatley, J
中科院分区：
文献类型：
--
作者：
Flemons, WW;Douglas, NJ;Wheatley, J
研究背景在成人睡眠中，短暂的呼吸停止（呼吸暂停）或Vt显著降低（呼吸不足）是常见的。前瞻性研究表明，睡眠呼吸暂停会导致全身性高血压（1），是机动车事故的一个可改变的风险因素（2），其对生活质量的不良影响是可以治疗的（3-6）。因此，患者对获得诊断研究和有效治疗的需求不断增长。当需求超过容量时，就会产生等待时间。需求受到以下因素的影响：（1）睡眠呼吸暂停的患病率和发病率，（2）费用和患者报销政策，（3）患者和主治医生的意识，以及（4）等待时间。能力取决于（1）由资助政策确定的睡眠实验室床位的可用性，（2）遵守美国睡眠医学学会（7）和美国胸科学会（8）发布的诊断睡眠呼吸暂停和持续气道正压（CPAP）滴定的指南，（3）睡眠专家的可用性，以及，（4）关于谁可以订购/解释诊断性多导睡眠图和CPAP滴定研究的政策。本文介绍了来自五个国家的信息，包括其人口、每年进行的睡眠研究数量、患者经历的等待时间范围以及用于处理需求和容量之间不匹配的一些策略（表1）。
BACKGROUNDBrief periods of breathing cessation (apneas) or marked reduction in V t (hypopneas) are common in adults during sleep. Prospective studies indicate that sleep apnea contributes to systemic hypertension (1), is a modifiable risk factor for motor vehicle accidents (2), and that its adverse impact on quality of life is treatable (3–6). As a result, there is substantial and growing demand by patients to access diagnostic studies and effective treatment. Wait times result when demand exceeds capacity. Demand is influenced by (1) prevalence and incidence of sleep apnea,(2) cost and patient reimbursement policies,(3) patient and primary physician awareness, and (4) wait times. Capacity is dictated by (1) availability of sleep laboratory beds determined by funding policies,(2) adherence to guidelines for diagnosing sleep apnea and continuous positive airway pressure (CPAP) titration published by the American Academy of Sleep Medicine (7) and the American Thoracic Society (8),(3) availability of sleep specialists, and,(4) policies about who can order/interpret diagnostic polysomnography and CPAP titration studies. This article represents information from five countries regarding their population, annual number of sleep studies performed, the range of wait times patients experience, and some strategies used for dealing with the mismatch between demand and capacity (Table 1)