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I priincipi di trattamento

I priincipi di trattamento. Francesco Fanfulla Servizio Autonomo Medicina del Sonno Fondazione S. maugeri IRCCS Istituto Scientifico di Pavia. Mortality and RDI. Log Odds. 7.0. < 59 yr. > 59 yr. 6.0. 5.0. 4.0. 3.0. 2.0. 1.0. 0.0. 0-10. 11.-20. 20-40. >40. -1.0. RDI.

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I priincipi di trattamento

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  1. I priincipi di trattamento Francesco Fanfulla Servizio Autonomo Medicina del Sonno Fondazione S. maugeri IRCCS Istituto Scientifico di Pavia

  2. Mortality and RDI Log Odds 7.0 < 59 yr > 59 yr 6.0 5.0 4.0 3.0 2.0 1.0 0.0 0-10 11.-20 20-40 >40 -1.0 RDI

  3. Long-termCardiovascularOutcomes in Men with OSAS Controls n = 264 Snorers n = 377 Mild OSAH n = 403 Severe OSAH n = 235 OSAH with CPAP n = 372 JM Marin et al. Lancet 2005; 365:1046-1053

  4. SleepDisorderedBreathing and Mortality: Eighteen-Year Follow-up of the Wisconsin SleepCohortYoung et al. SLEEP, Vol. 31, No. 8, 2008 Mean age 48 yrs

  5. Marshall – Sleep 2008; 31: 1079-1085

  6. Cardiovascular disease and mortality in OSAS patients at baseline and after 10-yr follow-up Doherty et al. Chest 2005; 127: 2076-2084 *

  7. Low compliance to treatment decreases survival. Campos-Rodriguez et al. Chest 2005; 128: 624-633

  8. Depressione, irascibilità o aggressività Cambiamenti di personalità e disturbidell’umore Alterazione delle funzioni psichiche superiori Deficit dell’attenzione e della memoria Difficoltà di concentrazione Ridotta abilità manuale proporzionale al numero di apnee nel sonno Scarse performance lavorative o di studio per problemi visivi e psicomotori; queste alterazioni sono dovute alla frammentazione del sonno e alla conseguente ipossia cerebrale.

  9. Pierobon Sleep Medicine 2008

  10. Whywe need to treat OSA? • OSA: high prevalence of erectile dysfunction in man due to neuropathy development. • Strong correlation between the severity of nerve damage and severity of nocturnal hypoxia. Fanfulla et al Sleep 2000

  11. Riflesso bulbocavernoso in OSAS alterato normale

  12. Eccessiva sonnolenza diurna Sensazione soggettiva di un imperioso bisogno di sonno in una condizione non usuale (tempo e luogo) o episodio di addormentamento non intenzionale o in una condizione non usuale (tempo e luogo). American Sleep Disorders Association, ICSD.

  13. Driving, Sleep and Accidents Traffic Density N of Sleep-Related Accidents Relative Risk of Sleep-Related Accidents

  14. “un guidatore viene definito come sonnolento alla guida se diventa così sonnolento mentre guida da aver paura di addormentarsi e se tale severa sonnolenza durante la guida compaia almeno una volta su tre quando impegnato in un lungo tragitto autostradale”.

  15. Risk of sleep apnea in sleepy drivers 5.7 (1.3-24) 6.0 (1.1-32) 10.0 (1.5-66) Confounding variables: hypertension, body mass index, gender, age and snoring Masa AJRCCM 2000

  16. Accidents risk in sleepy drivers with/without sleep apnea 6.6 (1.1-44) 8.5 (1.2-59) 8.9 (1.3-62) % of drivers with accidents Confounding variables: hypertension, drugs causing sleepiness, body mass index, gender, age, alcohol consumed, insomnia, hours slept per night, work and sleep schedule, professional drivers, hours driven per month and years of driving. AHI

  17. Sleep, Driving and Sleep Apnea If we turn to medical matters, a recent meta-analysis points to Obstructive Sleep Apnea as the disease resulting in the highest risks of being involved in an accident with injuries Truls Vaa Impairments, Diseases, age and their relative risks of accidents involvement. Institute for Transport Economics, Oslo, Norway, 2003

  18. A 60 Km/h in 6 secondi si percorrono 100 metri

  19. DRIVING ABILITY IN SLEEP APNOEA PATIENTS BEFORE AND AFTER CPAP TREATMENT Mazza ERJ 2006

  20. Determinants Affecting Health-Care Utilization in Obstructive Sleep Apnea Syndrome Patients OSAS patients are heavy users of health-care resources. Age >65 years and female gender were the leading elements predicting the most costly OSAS patients, and not necessarily patients with a high BMI and classic OSAS severity indexes. This was due to higher comorbidity, ie, 10 to 30% more hypertension, ischemic heart disease, diabetes mellitus, and pulmonary disease. Ariel Tarasiuk, et al CHEST 2005; 128:1310–1314)

  21. Low Socioeconomic Status Is a Risk Factor for Cardiovascular Disease Among Adult OSAS Patients Requiring Treatment In addition to the already known traditional risk factors, low SES was found to be a novel independent risk factor for CVD among adult OSAS patients requiring treatment. Ariel Tarasiuk, et al CHEST 2006; 130:766–773)

  22. FUTURO Identificare (HTA) nuovi modelli gestionali: • Rete (modello HUB – Spoke – rete assistenziale territoriale) • Sistema piramidale (ambulatorio – DH – Degenza) • Reti ospedaliere • Modelli integrati

  23. FUTURO Cosa si chiede alla politica sanitaria: • Riconoscimento della specificità della medicina del sonno, compresa quella respiratoria (ICD – Nomenclatore) • Il riconoscimento dell’OSAS come malattia sociale • Escludere la CPAP dalla disciplina protesica

  24. Conclusioni • Fare in modo che il futuro da “minaccia” diventi promessa (o opportunità).

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