Apnea del sueño y conducción de vehículos. Recomendaciones para la interpretación del nuevo Reglamento General de Conductores en España / Sleep Apnea and Driving. Recommendations for Interpreting Spanish Regulations for Drivers

Los accidentes de tráfico son una de las principales causas de mortalidad en todo el mundo, y la somnolencia está claramente relacionada con ello. Entre la población con alto riesgo de padecer somnolencia al volante, y consecuentemente accidentes de tráfico, se encuentran las personas que tienen síndrome de apnea del sueño (SAHS) sin diagnosticar. El tratamiento con CPAP ha demostrado una disminución en el riesgo de accidentabilidad de conductores con SAHS. Es por ello que la Unión Europea ha incluido esta enfermedad entre los requisitos psicofísicos para obtener o mantener el permiso de conducción. Para cumplir con esta Directiva Europea, España ha actualizado el Reglamento de Conductores de manera acorde. Con el fin de facilitar la implementación de la nueva norma, un grupo de expertos de diferentes sociedades médicas e instituciones han elaborado la presente guía, que contiene cuestionarios de cribado de SAHS, criterios de diagnóstico y tratamiento y modelos estandarizados de informes a completar por los médicos (AU)

Road traffic accidents are one of the main causes of death worldwide and are clearly associated with sleepiness. Individuals with undiagnosed sleep apnea-hypopnea syndrome (SAHS) are among the population with a high risk of experiencing sleepiness at the wheel and, consequently, road traffic accidents. Treatment with continuous positive airway pressure (CPAP) has been shown to reduce the risk of accidents among drivers with SAHS. For this reason, the European Union has included this disease in the psychological and physical criteria for obtaining or renewing a driving license. To comply with this European Directive, Spain has updated its driving laws accordingly. To facilitate the implementation of the new regulations, a group of experts from various medical societies and institutions has prepared these guidelines that include questionnaires to screen for SAHS, diagnostic and therapeutic criteria, and physician's report templates (AU)

Sleep Apnea and Driving. Recommendations for Interpreting Spanish Regulations for Drivers. / Apnea del sueño y conducción de vehículos. Recomendaciones para la interpretación del nuevo Reglamento General de Conductores en España.

Road traffic accidents are one of the main causes of death worldwide and are clearly associated with sleepiness. Individuals with undiagnosed sleep apnea-hypopnea syndrome (SAHS) are among the population with a high risk of experiencing sleepiness at the wheel and, consequently, road traffic accidents. Treatment with continuous positive airway pressure (CPAP) has been shown to reduce the risk of accidents among drivers with SAHS. For this reason, the European Union has included this disease in the psychological and physical criteria for obtaining or renewing a driving license. To comply with this European Directive, Spain has updated its driving laws accordingly. To facilitate the implementation of the new regulations, a group of experts from various medical societies and institutions has prepared these guidelines that include questionnaires to screen for SAHS, diagnostic and therapeutic criteria, and physician's report templates.

Los trastornos de la respiración durante el sueño, la ventilación no invasiva y los cuidados críticos en ARCHIVOS DE BRONCONEUMOLOGÍA (junio de 2008- noviembre de 2009) / Sleep Respiratory Disorders, Non-Invasive Ventilation and Critical Care in ARCHIVOS DE BRONCONEUMOLOGÍA (June 2008-November 2009)

En el presente estudio, se analizan los trabajos publicados en ARCHIVOS DE BRONCONEUMOLOGÍA de junio de 2008a noviembre de 2009 que hacen referencia a los trastornos del sueño, la ventilación no invasiva y los cuidadoscríticos.La metodología empleada ha sido analizar los objetivos de los trabajos presentados, con sus principalesresultados y las refl exiones que han sugerido a los autores, planteándose muchas veces la posibilidad dedesarrollar nuevos trabajos de investigación.La revisión incluye no sólo los trabajos originales, sino también una refl exión acerca de las editoriales, artículosespeciales y trabajos de revisión(AU)

The present study analyses the works published in ARCHIVOS DE BRONCONEUMOLOGÍA from June 2008 to November2009 that mention sleep disorders, non-invasive ventilation and critical care.The methodology used was to analyse the objectives of the works submitted, with their main results andthe conclusions suggested by the authors, often putting forward the possibility of conducting new researchstudies.The review no only includes original articles but is also a refl ection on the editorials, special articles andreview works(AU)

[Efficacy of a training program on sleep apnea-hypopnea syndrome aimed at primary care physicians]. / Eficacia de un plan de formación en atención primaria sobre el síndrome de apneas-hipopneas durante el sueño.

OBJECTIVE: The level of clinical suspicion of sleep apnea-hypopnea syndrome (SAHS) among primary care physicians is low. The aim of this study was to analyze the impact of a primary care training program on the quality and quantity of referrals made due to suspected SAHS. MATERIAL AND METHODS: A group of 16 primary care physicians were offered the option of participating in a training program consisting of 2 talks-workshops, the provision of up-to-date information on SAHS and a form for making referrals according to an established protocol, and the opportunity to contact the sleep department at our hospital directly. Twenty-one primary care physicians who did not receive training served as the control group. We gathered data on the quantity and quality of referrals made by both groups for the period January through June 2005 and 2006, and recorded the number of both SAHS diagnoses made and patients prescribed treatment with continuous positive airway pressure. Data were analyzed in function of the primary care population assigned to each group. RESULTS: The training program was completed by 81.3% of the physicians. The number of referrals made by the training group increased 2.38-fold after the program (intergroup comparison, P=.0001). There was also a 2.36-fold increase in the percentage of cases of SAHS detected in the population (P=.0008), a 1.85-fold increase in the percentage of serious cases detected (P=.001), and a 2-fold increase in the number of patients prescribed continuous positive airway pressure (P=.009). Agreement between the data gathered by the physicians and the sleep specialist was significantly higher in the training group for all the items studied. CONCLUSIONS: The implementation of a training program on SAHS aimed at primary care physicians improved both the quantity and quality of referrals made due to suspected SAHS.

Eficacia de un plan de formación en atención primaria sobre el síndrome de apneas-hipopneas durante el sueño / Efficacy of a training program on sleep apnea hypopnea syndrome aimed at primary care physicians

Objetivo: El grado de sospecha clínica del síndrome de apneas-hipopneas durante el sueño (SAHS) entre los médicos de atención primaria (MAP) es bajo. El propósito del presente trabajo ha sido analizar el impacto de un plan de formación dirigido a los MAP en la calidad y cantidad de las derivaciones realizadas por sospecha de SAHS. Material y métodos: Se ofreció a un grupo de 16 MAP un plan de formación consistente en 2 charlas-talleres, información actualizada sobre SAHS, una hoja de derivación protocolizada y contacto directo con la Unidad de Sueño. Un grupo de 21 MAP no formados sirvió como grupo control. Desde enero a junio de 2005 y 2006 se recogieron de ambos grupos datos referentes a la cantidad y calidad de las derivaciones realizadas según la población asignada a cada grupo, así como diagnósticos de SAHS y número de tratamientos prescritos con presión positiva continua de la vía aérea. Resultados: El 81,3% de los MAP siguió el plan de formación. El porcentaje de población asignada que fue derivada a la Unidad de Sueño aumentó en 2,38 veces tras el plan de formación en el grupo que la recibió (p intergrupos = 0,0001). Hubo un incremento de 2,36 veces en el porcentaje de población diagnosticada de SAHS (p intergrupos = 0,008), de 1,85 veces en SAHS graves (p intergrupos = 0,001) y de 2 veces en tratamientos prescritos con presión positiva continua de la vía aérea (p intergrupos = 0,009). La concordancia entre la información recogida por los MAP y por el especialista mejoró de forma significativa en todos los ítems estudiados. Conclusiones: La implantación de un plan de formación sobre SAHS dirigido a MAP resultó eficaz en la mejora de la cantidad y calidad de las derivaciones realizadas por sospecha de SAHS

Objective: The level of clinical suspicion of sleep apnea­hypopnea syndrome (SAHS) among primary care physicians is low. The aim of this study was to analyze the impact of a primary care training program on the quality and quantity of referrals made due to suspected SAHS. Material and Methods: A group of 16 primary care physicians were offered the option of participating in a training program consisting of 2 talks­workshops, the provision of up-to-date information on SAHS and a form for making referrals according to an established protocol, and the opportunity to contact the sleep department at our hospital directly. Twenty-one primary care physicians who did not receive training served as the control group. We gathered data on the quantity and quality of referrals made by both groups for the period January through June 2005 and 2006, and recorded the number of both SAHS diagnoses made and patients prescribed treatment with continuous positive airway pressure. Data were analyzed in function of the primary care population assigned to each group. Results: The training program was completed by 81.3% of the physicians. The number of referrals made by the training group increased 2.38-fold after the program (intergroup comparison, P=.0001). There was also a 2.36-fold increase in the percentage of cases of SAHS detected in the population (P=.0008), a 1.85-fold increase in the percentage of serious cases detected (P=.001), and a 2-fold increase in the number of patients prescribed continuous positive airway pressure (P=.009). Agreement between the data gathered by the physicians and the sleep specialist was significantly higher in the training group for all the items studied. Conclusions: The implementation of a training program on SAHS aimed at primary care physicians improved both the quantity and quality of referrals made due to suspected SAHS

[Health-related quality of life of patients receiving home mechanical ventilation: the Spanish version of the severe respiratory insufficiency questionnaire]. / Calidad de vida relacionada con la salud de pacientes en programa de ventilación mecánica domiciliaria. La versión española del cuestionario SRI.

OBJECTIVE: Home mechanical ventilation is used with patients with severe, chronic respiratory failure, a condition that has a serious impact on quality of life. The aim of this study was to produce a translation and cultural adaptation of the Severe Respiratory Insufficiency. Questionnaire for the Spanish population, the first health-related quality of life questionnaire specifically designed for patients receiving home mechanical ventilation. METHODS: Four bilingual German-Spanish translators were used to translate and back-translate the questionnaire. Meetings were held with the translators following each step of the translation process to produce a single version that could be used in the next step. At the end of the process, the questionnaire was piloted to assess its comprehensibility. A scoring system using a scale of 1 (lowest) to 10 (highest) was used to rate both translation difficulty and the naturalness of the language produced. The equivalence of the original and translated items was also evaluated. RESULTS: Three Spanish versions of the questionnaire were produced. Task difficulty was rated as quite low: the mean (SD) ratings were 1.4 (0.6) for translation and 2.2 (1.1) for back translation. The naturalness of the translated items was rated as very high, with scores improving with the successive versions (version 1, 8.4; version 2, 8.7; version 3, 9.1; P< .001). Thirty of the questionnaire items (61.2%) were judged to be fully equivalent, 13 (26.5%) to be similar, and 6 (12.2%) to be non-equivalent. The meaning conveyed by 5 of the items was changed or clarified during piloting. CONCLUSIONS: The translation of the questionnaire using the translation-back-translation procedure has produced a version that is both comparable to the original and accessible to the Spanish population. Its validity is currently being tested in a multicenter study.

Calidad de vida relacionada con la salud de pacientes en programa de ventilación mecánica domiciliaria. La versión española del cuestionario SRI / Health-related quality of life of patients receiving home mechanical ventilation: the spanish version of the severe respiratory insufficiency questionnaire

Objetivo: La ventilación mecánica domiciliaria se aplica a pacientes con insuficiencia respiratoria crónica y grave, lo que tiene un impacto considerable en su calidad de vida. El objetivo de este trabajo ha sido realizar una traducción y adaptación transcultural para la población española del cuestionario Severe Respiratory Insuficiency (SRI), el primer cuestionario de calidad de vida relacionada con la salud específico para estos pacientes. Métodos: Intervinieron 4 traductores bilingües alemán-español siguiendo el método de la traducción y retrotraducción. Después de cada paso se realizaron reuniones con los traductores para obtener una versión única antes de continuar. Al final del proceso se realizó una prueba piloto para valorar su comprensibilidad. El proceso de traducción se evaluó en dificultad y naturalidad, mediante una escala entre 1 (mínimo) y 10 (máximo), así como en equivalencia de los ítems con la versión original. Resultados: Se obtuvieron 3 versiones en español. La dificultad de la traducción fue considerablemente baja para la traducción (media ± desviación estándar) 1,4 ± 0,6) y la retrotraducción (2,2 ± 1,1). La naturalidad de los ítems fue muy elevada y mejoró con las sucesivas versiones (versión 1: 8,4; versión 2: 8,7; versión 3: 9,1; p < 0,001). Se catalogaron como totalmente equivalentes 30 ítems (61,2%), 13 (26,5%) fueron similares y 6 (12,2%) no fueron equivalentes. Durante la prueba piloto se matizaron 5 ítems. Conclusiones: La traducción del cuestionario siguiendo el método de la traducción-retrotraducción ha dado una versión española equiparable a la original y asequible para los pacientes. Actualmente se está llevando a cabo la validación del cuestionario mediante un estudio multicéntrico

Objective: Home mechanical ventilation is used with patients with severe, chronic respiratory failure, a condition that has a serious impact on quality of life. The aim of this study was to produce a translation and cultural adaptation of the Severe Respiratory Insufficiency. Questionnaire for the Spanish population, the first health-related quality of life questionnaire specifically designed for patients receiving home mechanical ventilation. Methods: Four bilingual German-Spanish translators were used to translate and back-translate the questionnaire. Meetings were held with the translators following each step of the translation process to produce a single version that could be used in the next step. At the end of the process, the questionnaire was piloted to assess its comprehensibility. A scoring system using a scale of 1 (lowest) to 10 (highest) was used to rate both translation difficulty and the naturalness of the language produced. The equivalence of the original and translated items was also evaluated. Results: Three Spanish versions of the questionnaire were produced. Task difficulty was rated as quite low: the mean (SD) ratings were 1.4 (0.6) for translation and 2.2 (1.1) for back translation. The naturalness of the translated items was rated as very high, with scores improving with the successive versions (version 1, 8.4; version 2, 8.7; version 3, 9.1; P<.001). Thirty of the questionnaire items (61.2%) were judged to be fully equivalent, 13 (26.5%) to be similar, and 6 (12.2%) to be non-equivalent. The meaning conveyed by 5 of the items was changed or clarified during piloting. Conclusions: The translation of the questionnaire using the translation-back-translation procedure has produced a version that is both comparable to the original and accessible to the Spanish population. Its validity is currently being tested in a multicenter study