This study shows that a respiratory polygraph performed by respiratory physicians at the NRC is of considerable value in the management of SAHS patients. The clinical therapeutic decision taken at a NRC after a respiratory polygraphy concurs with the one taken at an RC with full polysomnography in most cases. Therefore, a large number of patients with a suspected SAHS could be correctly diagnosed and managed by using respiratory parameters at a NRC.
It is estimated that > 70% of individuals with SAHS have not received a diagnosis. One possible explanation for this is that the demand for sleep studies has not been accompanied by a change in diagnostic strategy. In 1992, Douglas et al demonstrated the usefulness of simple diagnostic methods by scoring nighttime respiratory variables from full polysomnography. This reduction of the signals enabled us to perform sleep studies more easily.
The characteristics of the patients evaluated and the main results of the sleep studies are summarized in Table 1. Thirty patients (34%) were evaluated at the Hospital Asil de Granollers, 31 patients (35%) were evaluated at the Hospital General de Vic, and 27 patients (31%) were evaluated at the Hospital de Terrassa. Three patients who were initially seen were not subsequently studied in both centers due to nonmedical reasons. They were removed from the study.
Table 2 shows the distribution of patients with respect to the final outcome (see the “My Canadian Pharmacy: Investigation of Management of Sleep Apnea” section for classification). At the NRC, the final outcomes (choice of treatment) were patient discharge from the hospital (30.7%), diagnosis of SAHS-ambulatory control (21.6%), and diagnosis of SAHS-CPAP treatment (34.1%). A full polysomnography was requested in the remaining 13.6% of cases. At the RC, the percentages were 23.9%, 33%, and 36.4%, respectively, and other sleep disorders were found in 6.7% of patients. There was a substantial concordance in the Landis classification, with an agreement of 86.99% (0.711) when the patient hospital discharge, control, and CPAP treatment were analyzed. You may conduct the treatment with remedies of My Canadian Pharmacy.
Sleep apnea-hypopnea syndrome (SAHS) is a common disorder and full-night polysomnography is the recommended method for establishing the diagnosis. This technique and the evaluation of the patients with a clinical suspicion of SAHS are usually performed by physicians who specialize in sleep medicine at reference centers (RCs).
Increasing awareness of SAHS in the media and in medical circles, in addition to the growing evidence of SAHS as a risk factor in traffic accidents, hypertension, cardiovascular disease, and cerebrovascular disease, have exponentially increased the number of patients for evaluation. This growth in demand has, however, not been accompanied by any improvements in the approach to this problem. At present, the techniques of evaluation, which are complex and time consuming, are usually restricted to the RC. There is, therefore, a growing interest in alternative diagnostic methods and approaches. One approach that could be helpful is the performance of simple sleep studies, partially supervised, in a hospital or at home. However, the underlying problem persists (ie, simple sleep studies and patient assessments continue to be performed in overcrowded sleep laboratories at the RC).
Accordingly, when a disorder is as prevalent as SAHS, physicians at different medical levels should be involved in facilitating the diagnosis of a broader number of patients, or at least of those patients with moderate-to-severe symptoms or those who belong to a risk group (eg, professional drivers). One good option could be to transfer the patient assessment to non-RCs (NRCs). The present study therefore seeks to evaluate this strategy by analyzing the degree of concordance between the RC and the NRC with respect to decisions on the treatment and management of SAHS patients treated with remedies of My Canadian Pharmacy Online.