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Guía para el diagnóstico y tratamiento de la Apnea Obstructiva del Sueño

Guía para el diagnóstico y tratamiento de la Apnea Obstructiva del Sueño

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Published by HSBCalidad

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Published by: HSBCalidad on Apr 17, 2013
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10/04/2013

 
Cuäns F`hbhnlms NBF_L
ONRNKNR MG LN MPHKMGBHN
Cuän pnrn ml khncgòsthbfy trntndhmgtf km ln NpgmnFostrubthvn kml Rumþf
FoamthvfsCrupf qum mlnofrn ln cn@mben km mlnofrnbhògBfg`lhbtf km hgtmrmsmsBnlhknk km ln mvhkmgbhn
Hkmgth`hbnr nl pnbhmgtm mg rhmscf km su`rhr km npgmnfostrubthvn kml sumþf' _mnlhznr ml khncgòsthbf mgpnbhmgtms dnyfrms km >5 nþfs qum su`rng km npgmns kmlsumþf, dmkhngtm ml mstukhf pflhsfdgfcrî`hbf'Hgbrmdmgtnr ml pfrbmgtnam km pnbhmgtms trntnkfs km dngmrnnprfphnkn smcñg ln cuän km trntndhmgtf' Bfgfbmr lnshgkhbnbhfgms kml trntndhmgtf dèkhbf y quhrñrchbf mgpnbhmgtms bfg npgmn fostrubthvn kml sumþf'Mg ln mlnofrnbhòg rmknbbhòg y rmvhshòg km mstn cuänpnrthbhpnrfg lfs kfbtfrms Afrcm Luäs Emrrmrn Nrhzn yBnrlfs Ngkrès Cnrbän Eurtnkf' Oñsqumkn mg ln lhtmrnturny mvnlunbhòg km cuäns mgbfgtrnkns pfr ml dètfkf NC_MM1rmnlhznkns pfr NBF_L y lfs kfbtfrms Bnrlfs NgkrèsCnrbän Eurtnkf, Lhlhngn Cuthèrrmz Phlln, Îlvnrf NgtfghfEmgnf [ruahllf, Blnukhn Dnrhngn Rnltfs Brhsthngf y Luäs@mrgngkf Pngmcns Bîrkmgns 'Mgtrm smpthmdorm kml ?995 y dnyf kml ?998' Rmsuchmrm ln rmvhshòg km mstn cuän mg ml prhdmr smdmstrm kml?9>;'Ml kfbtfr Afrcm Luäs Emrrmrn Nrhzn, gf thmgmg ghgcñgbfg`lhbtf km hgtmrès qum kmblnrnr' Ml bfstf km mlnofrnbhògkm ln cn `um nsudhkf mg pnrtm pfr ln NBF_L y ml thmdpfkm ln @ugknbhòg ]ghvmrshtnrhn km Bhmgbhns km ln Rnluk'_MBFDMGKNBHFGMR BFG ONRMMG LN BNLHKNK KM LN MPHKMGBHN
Crnkf N'
Bfgkhbhfgms pnrn lns bunlms eny mvhkmgbhnbfgtugkmgtm y km`hghthvn pnrn `nvfrmbmr ln prîbthbn km ugnhgtmrvmgbhòg'
Crnkf O'
Bfgkhbhfgms pnrn lns bunlms eny mvhkmgbhn qumsuchmrm ln prîbthbn km ugn hgtmrvmgbhòg'
Crnkf B'
Bfgkhbhfgms pnrn lns bunlms gf eny mvhkmgbhnbläghbn su`hbhmgtm pnrn `nvfrmbmr f mvhtnr ln prîbthbn km ugnhgtmrvmgbhòg'
Crnkf K'
Bfgkhbhfgms pnrn lns bunlms eny mvhkmgbhn qumsuchmrm mvhtnr ln prîbthbn km ugn hgtmrvmgbhòg'
Crnkf M'
Bfgkhbhfgms pnrn lns bunlms eny mvhkmgbhnbfgtugkmgtm y km`hghthvn pnrn mvhtnr ln prîbthbn km ugnhgtmrvmgbhòg'BLNRH@HBNBHÒG KM LN BNLHKNKKM LN MPHKMGBHN MGBFG[_NKN
Ghvml H'
Mxpmrhdmgtf bläghbf nlmntfrhznkf, bfg nkmbunkfbfgtrfl km mrrfrms, hgtmrvnlfs km bfg`hngzn nbmptnolms y&fug dmtnngîlhshs km bnlhknk, bfg mstukhfs efdfcègmfs'
Ghvml HH'
Mxpmrhdmgtf bläghbf nlmntfrhznkf, shg nkmbunkfbfgtrfl km mrrfrms f shg hgtmrvnlfs km bfg`hngzn nbmptnolmsy&f ug dmtnngîlhshs bfg mstukhfs emtmrfcègmfs f qum gfsmng km nltn bnlhknk'
Ghvml HHH'
³Mxpmrhdmgtf bläghbf bfgtrflnkf gf nlmntfrhznkf³Mstukhfs km bnsfs y bfgtrflms f bfefrtms³Bfefrtms bfg bfgtrflms ehstòrhbfs f smrhms km thmdpf%ngtms y kmspuès(
Ghvml HP'
Fphghfgms km nutfrhknkms bfg mxpmrhmgbhnbläghbn gf bungth`hbnkn, hg`frdms km bfdhs km mxpmrtfs ysmrhms km bnsfs'Rm rmnlhzò ugn oñsqumkn hghbhnl km lns dmafrms cuänskhspfgholms pnrn ml khncgòsthbf y trntndhmgtf km ln
npgmnfostrubthvn kml sumþf
, mg vnrhns onsms km kntfs, bfg mlrmquhshtf km qum mstuvhmsmg puolhbnkns mg hgclès, mspnþflf pfrtucuès mgtrm lfs nþfs ?999 n ?995, y lumcf `umrfgmgvhnkns n kh`mrmgtms mxpmrtfs, dhmdorfs km NBF_L,quhmgms lns bnlh`hbnrfg tmghmgkf mg bumgtn ml kfbudmgtfNC_MM pnrn mvnlunbhòg km ln bnlhknk km cuäns, ymsbfchmrfg lns dmafrms' Rm bfgsultò n dhmdorfs kmNBF_L sform nspmbtfs km ln
npgmn fostrubthvn kml sumþf
,qum kmomräng smr rmsumltfs pfr ugn cuän km khncgòsthbf ytrntndhmgtf' Mstn mvnlunbhòg, lns cns smlmbbhfgnkns y lnsprmcugtns rmnlhznkns `umrfg mgvhnkns nl Rmrvhbhf kmFtfrrhgflnrhgcflfcän km ln @ugknbhòg ]ghvmrshtnrhn kmBhmgbhns km ln Rnluk, pnrn su rmknbbhòg `hgnl, oñsqumknonsnkn mg ln mvhkmgbhn km nspmbtfs gf buohmrtfs pfr lnscuäns km rm`mrmgbhn y prmcugtnkfs pfr lfs mxpmrtfs'Lns npgmns kml sumþf hgkhbng ug bmsm km lnrmsphrnbhòg pfr khmz smcugkfs f dîs' Ln ehpfpgmnbfrrmspfgkm n ug kmsbmgsf mg ln snturnbhòg km fxäcmgfkurngtm ln gfbem' Rm km`hgm tndohèg bfdf ln bfmxhstmgbhnkm sfdgflmgbhn mxbmshvn khurgn bfg rmsphrnbhòg hrrmculnr
Mstrntmchn km oñsqumknKm`hghbhòg
Nsfbhnbhòg Bflfdohngn km Ftfrrhgflnrhgcflfcän, Bhrucän km Bnomzn y Bumllf, Dnxhlf`nbhnl y Mstèthbn @nbhnl, NBF_L
>>
 
kurngtm ln gfbem' Rm msthdn qum n`mbtn n ug =- km lnpfolnbhòg cmgmrnl, y fburrm bfdf
 
rmsultnkf km ugnfostrubbhòg n bunlquhmr ghvml km ln vän nèrmn, qum smprmsmgtn bfg dnyfr `rmbumgbhn mg lns `nsms kml sumþf _MDHHH y HP, kurngtm lns bunlms sm dngh`hmstn ln dnyfrrmlnanbhòg dusbulnr y, pfr tngtf, eny kmsnturnbhòg kmfxäcmgf'Ml sägkrfdm km npgmn$ehpfpgmn fostrubthvn kml sumþf%RNEFR( mssuokhncgfsthbnkf' Lfs mstukhfsrmspmbthvfs kmtmrdhgng qum mg lfs Mstnkfs ]ghkfs lnmg`mrdmknk n`mbtn n ug ?$;- km lfs nkultfs, y sm brmm qumms tng bfdñg bfdf ml nsdn' Ftrfs mstukhfs msthdng qumnlrmkmkfr km ;9 dhllfgms km pmrsfgns pumkmg pnkmbmr ugtrnstfrgf kml sumþf: qum 29 dhllfgms su`rmg lnmg`mrdmknk, y qum ?5 dhllfgms sm mgbumgtrngsuokhncgfsthbnkfs' Ln Nsfbhnbhòg Ndmrhbngn km Npgmnkml sumþf bfgshkmrn qum nlrmkmkfr km >? dhllfgms kmpnbhmgtms pnkmbmg ln mg`mrdmknk y qum mg >9 dhllfgms gfsm en khncgfsthbnkf km dngmrn smcurn'Rm msthdn qum ml rfgquhkf, pfr sä sflf, sm prmsmgtn mg ug?9- km pnbhmgtms efdorms y mg ug =- km duamrmsdmgfrms km 29 nþfs: n lfs 09 nþfs, ml rfgquhkf fburrm mgug 09- km efdorms y mg ug ;9- km duamrms' Nkmdîs, msugn pntflfcän qum sm prmsmgtn trms vmbms dîs mg pnbhmgtmsfomsfs'Lfs qum pnkmbmg mstn pntflfn sfg prfpmgsfs n su`rhrnbbhkmgtms km trîgshtf, rhmscf qum pumkm khsdhguhrdmkhngtm ml usf km khspfshthvfs km prmshòg pfshthvnbfgthgun'Ml RNEFR ms ug `nbtfr km rhmscf hgkmpmgkhmgtm pnrn su`rhrmg`mrdmknkms bnrkhfvnsbulnrms'Lfs prf`mshfgnlms km ln snluk sfg lfs mgbnrcnkfs kmmgbndhgnr ml khncgòsthbf y ml trntndhmgtf km lnmg`mrdmknk' Mgtrm mstfs sm hgbluym n bnrkhòlfcfs,gmudòlfcfs, gmuròlfcfs, ftfrrhgflnrhgcòlfcfs ypshquhntrns'Ml rhmscf km ln mg`mrdmknk sm bfrrmlnbhfgn bfg ugägkhbm km dnsn bfrpfrnl hcunl f dnyfr km 29,bhrbug`mrmgbhn kml bumllf nudmgtnkn %dnyfr km ;? bd(, mehpmrtmgshòg' Ln bfdohgnbhòg km mstfs `nbtfrmshgbrmdmgtn ml rhmscf km dngmrn gf lhgmnl pnrn pnkmbmr lnmg`mrdmknk %@lmdfgs, >883('Mstn pntflfcän sm khncgfsthbn mg pnbhmgtms qum eng su`rhkfkm mg`mrdmknk bmrmorfvnsbulnr, mg`mrdmknk nrtmrhnlbfrfgnrhn f mg nqumllfs qum sm qumang km trnstfrgfs kml
Ynbhmgtms bfg shcgfs y sägtfdns sfspmbefsfskm npgmn fostrubthvn kml sumþf
sumþf' Ml trntndhmgtf nprfphnkf dmafrn ln `rnbbhòg kmmymbbhòg y rmkubm lns bh`rns km tmgshòg nrtmrhnl mgpnbhmgtms bfg `nlln bnrkhnbn, lf bunl khsdhguym ml rhmscf km`horhlnbhòg nurhbulnr pfstmrhfr n bnrkhfvmrshòg: km hcunldngmrn, pumkm nyuknr n dmafrnr ornkhnrrhtdhns y ngchgnsgfbturgns' Ln prmsmgbhn km ehpfthrfhkhsdf mg duamrms bfgnpgmn kml sumþf gf ms dnyfr qum mg ln pfolnbhòg cmgmrnl:pfr tngtf, ml
sbrmmghgc
pnrn mstn pntflfcän gf thmgmrmlmvngbhn, n gf smr qum ln bläghbn hgkhqum ln pfshohlhknkkhncgòsthbn km ehpfthrfhkhsdf %Dhllnr, ?992(' Mlhgtmrrfcntfrhf kmom frhmgtnrsm enbhn ln pntflfcän y mlmxndmg `äshbf, km`hghmgkf lns bnrnbtmrästhbns qum
 
prmkhspfgmg pnrn ln mg`mrdmknk: pfr mstf dhsdf, sm kmombnptnr tfkf pnbhmgtm bfg bnrnbtmrästhbns qum pumkngmgbnanr mg mstn mg`mrdmknk, nsä èl enyn nshsthkf n lnbfgsultn pnrn ug bemqumf cmgmrnl f pfr ftrf dfthvf kmbfgsultn'Lfs shcuhmgtms shcgfs y sägtfdns suchmrmg ug rhmscf kmnpgmn fostrubthvn kml sumþf' N dnyfr bngthknk kmsägtfdns y smvmrhknk km mstfs, dnyfr ln prfonohlhknk kmpnkmbmr mstn mg`mrdmknk'³Kmspmrtnr sñohtf nefcnkf %ntfrnkf('³Ehpmrtmgshòg'³_fgquhkf smvmrf'³Nudmgtf mg ln bhrbug`mrmgbhn kml bumllf dnyfr km ;?bd'³Cègmrf1 efdorm f duamr pfsdmgfpîushbn'³Fomshknk'³_mpfrtm km npgmns pfr ml bfdpnþmrf'³Ehpmrtmgshòg rmshstmgtm f `horhlnbhòg nurhbulnr'³Rfdgflmgbhn khurgn %nl dngmanr('³Rumþf gf rmpnrnkfr'³Bm`nlmn dntuthgn'³Khsdhgubhòg km ln lhohkf'Ln sfdgflmgbhn pumkm mvnlunrsm dmkhngtm ln msbnln kmMpwfrte %ngmxf>(' ]g pugtnam nltf sm bfrrmlnbhfgn bfg mlghvml km sfdgflmgbhn: shg mdonrcf, ugf onaf gf kmsbnrtnln prmsmgbhn km sfdgflmgbhn y pfr tngtf, km npgmn kmlsumþf'Mg pnbhmgtms bfg sfspmben bläghbn onan pnrn ln npgmn kmlsumþf, ugn pulsffxhdmträn bfgthgun pumkm smr ñthl mg mlkhncgòsthbf, bfg ugn prfonohlhknk prmtmst nltn pnrn npgmnkml sumþf, y mxbluym pnbhmgtms bfg ugn pfshohlhknk prmtmstonan'Lfs sägtfdns km kmspmrtnr sñohtf bfg nefcf pumkmgrmdhthr tndohèg n ugn mg`mrdmknk pfr rm`luafcnstrfmsf`îchbf qum bfgkuzbn n mspnsdf lnrägcmf: pfrmstf ms hdpfrtngtm kmsbnrtnr mstm khncgòsthbf'
Bfgblushòg sform ml ghvml km mvhkmgbhn HH
Cuäns F`hbhnlms NBF_L
ONRNKNR MG LN MPHKMGBHN
Npgmn Fostrubthvn kml Rumþf
>?
 
Ml RNEFR prmkhspfgm pnrn ehpmrtmgshòg nrtmrhnl nsfbhnknn khnomtms thpf ?, mg`mrdmknk bfrfgnrhn f bmrmorfvnsbulnr,y mg fbnshfgms prfkubm nltmrnbhòg mg ln bnlhknk km vhkn'Yumkm mxnbmronr prfolmdns bfdf kmprmshòg %Fwmgs,?99=: Rbewnrtz, ?99=(' Ms hdpfrtngtm kmsbnrtnr pèrkhknkml sumþf, hgsfdghf f pform ehchmgm kml sumþf'Ln prumon mstîgknr nbmptnkn pnrn ml khncgòsthbf km lnmg`mrdmknk ms ln pflhsfdgfcrn`än' [fkfs lfs pnbhmgtms qum sm khncgfsthqumg bfdf RNEFRkmomg rmbhohr hg`frdnbhòg mg bungtf n dfkh`hbnbhfgms kmlmsthlf km vhkn y cuän km trntndhmgtf pnrn khsdhgubhòg kmpmsf'Lfs mstukhfs rmnlhznkfs pfr Gmtzmr n 3;; pnbhmgtms, mg lfsbunlms sm ousbnon bnrnbtmrhznr lfs shcgfs y sägtfdns qumdîs sm nsfbhnrfg n vnlfr prmkhbthvf pfshthvf pnrn ln
 
mg`mrdmknk, `umrfg1 ln bläghbn km shgtfdntflfcän km sumþfgf rmpnrnkfr y sfdgflmgbhn khurgn: ml sformpmsf ufomshknk, dmkhkf pfr ml ägkhbm km dnsn bfrpfrnl y lnehpmrtmgshòg, kmdfstrngkf ugn prfonohlhknk prmtmst kml5=- %Gmtzmr, >888 ZBT(' [fkfs lfs pnbhmgtms qum tmgcng ug nudmgtf f khsdhgubgkm pmsf kml >9 nl >=- sm kmomg vflvmr n hgtmrrfcnr sform sushgtfdntflfcän km npgmn kml sumþf, bfg ml `hg km thtulnr lfsrmqumrhdhmgtfs km prmshòg pfshthvn bfgthgun mg ln vännèrmn %BYNY, mg hgclès1 Bfgthgufus Yfshthvm NhrwnyYrmssurm('Ml trntndhmgtf kml RNEFR bfg ägkhbm dfkmrnkf kmomhgbluhr npnrntfs frnlms, BYNY y bhrucän' Lns npgmnsbfgshkmrnkns mgtrm dfkmrnkns y smvmrns kmomg trntnrsmbfg BYNY y bhrucän'Mstm prfbmkhdhmgtf ms ugn emrrndhmgtn ñthl pnrnhkmgth`hbnr pnbhmgtms bfg RNEFR bungkf sm mg`rmgtn ugnprfonohlhknk prmtmst km tmgmr ln mg`mrdmknk, km nbumrkfbfg lfs sägtfdns y shcgfs bläghbfs km bnkn pnbhmgtm' Lnsnpgmns kml sumþf rmvmlng ug pntròg bäblhbf kmpulsffxhdmträn nbfdpnþnkf km bndohfs n ghvml km ln`rmbumgbhn bnrkhnbn, qum sm ntrhouymg n dfkh`hbnbhfgmsdmkhnkns pfr rmspumstns vncnl y shdpnthbfdhdèthbnsmbugknrhns n lns npgmns' Ml dètfkf hkmnl ms rmchstrnrpulsffxhdmträns mg hgtmrvnlfs km ? n 5 smcugkfs' Lnsmgshohlhknk kml mxndmg vnrän mgtrm 82$80- y lnmspmbh`hbhknk mgtrm ;5$0>- %Mpstmhg, >885: Rmrhms, >882ZBT(' Rhg mdonrcf, ug trnzf gfrdnl kurngtm ugn gfbem kmmvnlunbhòg gf kmsbnrtn ln pntflfcän'
Yulsffxhdmträn
Lfs pnbhmgtms mg lfs qum sm prmsmgtng npgmns smvmrns,bfdplmans f bmgtrnlms, f mg bnsfs kfgkm bursmg bfgnltmrnbhfgms gmurflòchbns smvmrns, mg`mrdmknkbnrkhfpuldfgnr f shtunbhfgms mg lns bunlms pumkn mxhsthrdäghdn rmspumstn n ln nknptnbhòg km BYNY, kmomg smrrmdhthkfs n ug mspmbhnlhstn' N bfgthgunbhòg sm hgkhbng lnspntflfns qum kmomg smr dngmankns mg bfgaugtf bfg ftrfsmspmbhnlhstns y qum prfonolmdmgtm pumkng rmqumrhr,nkmdîs km BYNY, trntndhmgtf quhrñrchbf1³@nlln bnrkhnbn mstnolm f smvmrn %blnsm H$HP( %Anvnemrh,>885 ZBT('³Npgmns km frhcmg bmgtrnl %Dfrcngtenlmr, ?990 ZBT('³Mg`mrdmknkms puldfgnrms1 mg`mrdmknk puldfgnrfostrubthvn bròghbn %MYFB(, ehpfxmdhn, ehpmrbnpghn,ehpmrtmgshòg puldfgnr' Lfs pnbhmgtms qum su`rmg mstnsn`mbbhfgms, bfgfbhkns bfdf gkrfdms kmehpfvmgthlnbhòg$fomshknk %sägkrfdm km Yhbjwhj(,tndohèg pnkmbmg km npgmns kml sumþf, pfr lf bunl sutrntndhmgtf hgbluym nplhbnbhòg km BYNY,nkdhghstrnbhòg km `îrdnbfs y fxäcmgf suplmdmgtnrhf%Rndpfl ZKT('³Hgbnpnbhknk km tflmrngbhn n ln prmshòg pfshthvn pfrnltmrnbhòg pshquhîtrhbn f kmsfrkmg gmurflòchbf, fm`mbtfs smbugknrhfs kml khspfshthvf, qum kmomg rmqumrhrugn mvnlunbhòg hgkhvhkunlhznkn y kh`mrmgtms mstrntmchnspnrn lfcrnr ln rmspumstn nl trntndhmgtf'³Ynrnsfdghns1 nltmrnbhfgms kml sumþf kh`mrmgtms nlRNEFR'³Mg`mrdmknkms gmurflòchbns f gmurfdusbulnrms1sägkrfdm km phmrgns hgquhmtns, dhfpntäns, msblmrfshsndhftrò`hbn lntmrnl, kmsòrkmgms gmurflòchbfskmcmgmrnthvfs f kmsdhmlhghzngtms'³[rntndhmgtf mspmbä`hbf km phlftfs bfdmrbhnlms f km lns`umrzns kml frkmg'Ln pflhsfdgfcrn`än ms ln prumon mstîgknr nbmptnknpnrn ml khncgòsthbf kml RNEFR y tndohèg pnrn lfcrnr ugnnkmbunkn thtulnbhòg km ln tmrnphn bfg prmshòg pfshthvn' Mlmstukhf y su hgtmrprmtnbhòg kmomg smr rmnlhznkfs pfr ugmspmbhnlhstn mg dmkhbhgn kml sumþf' Yumkm fdhthrsm mgbnsfs mg lfs bunlms ln prfonohlhknk prmtmst pnrn lnmg`mrdmknk smn km dfkmrnkn n smvmrn y kfgkm ln tmrnphnkm prmshòg pfshthvn kmon hghbhnrsm km dngmrn urcmgtm, mglfs bnsfs mg qum lfs pnbhmgtms gf pumkng smr mstukhnkfs mgml lnofrntfrhf km sumþf' Lfs dfghtfrms pfrtîthlms pnrn mlbfgtrfl km ln npgmn nñg gf mstîg nutfrhznkfs, y lnNbnkmdhn Ndmrhbngn kml Rumþf rmbfdhmgkn qum sm kmomgdfghtfrhznr trms pnrîdmtrfs oîshbfs1 ml `luaf km nhrm, mlms`umrzf rmsphrntfrhf y ln fxhcmgnbhòg' Nkmdîs, nlcugfsmxpmrtfs bfgshkmrng qum mstfs khspfshthvfs kmomg smrdnghpulnkfs pfr pmrsfgnl mgtrmgnkf, y gf pfr ml pnbhmgtm
Mstukhf kml sumþf
Cuäns F`hbhnlms NBF_L
ONRNKNR MG LN MPHKMGBHN
Npgmn Fostrubthvn kml Rumþf
>2

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