O PASSADO AQUI TÃO

PERTO...

… NA MEDICINA DO SONO

Clara Santos

Centro de Medicina do Sono do Hosp. Geral - CHUCoimbra

Santarém, Outubro 2014

EVOLUÇÃO HISTÓRICA

“O sono é o estado intermédio entre a vigília e a morte”

The Philosophy of Sleep, de Robert MacNish, 1834;

- As grandes descobertas na área do sono tem as suas raízes na descoberta das ondas cerebrais em Humanos, por A. Berger em 1930, e na descrição das diferenças entre a vigília e o sono.

-Loomis, 1937, foi o primeiro a mostrar dados sistematicamente colhidos, e usou-os para estabelecer correlações entre o sono comportamental e o sono documentado EEGraficamente

-Aserinsky e Kleitman, em 1953 foram os primeiros a incluir nas poligrafias noturnas que realizavam, o registo sistemático do EOG;

EVOLUÇÃO HISTÓRICA

- Dement descreve de seguida a descoberta dos

movimentos rápidos dos olhos (REMs) durante o

sono e associa-os com episódios de completa

activação do EEG.

- Jouvet demonstra que a actividade muscular é

completamente suprimida durante o sono REM.

Com base nestas descobertas, desde 1959, o

registo do EEG, do EOG e do EMG é usado na

Poligrafia Clinica.

“More has been learned about sleep in the last 60

years than in the preceding 6.000.”

(…)

“In this Short period of time, researchers have

discovered that sleep is a dynamic behavior. Not

simply the absence of waking, sleep is a special

activity of the brain, controlled by elaborate and

precise mechanisms”

Allan Hobson, Sleep (Scientific American Library

Series). 3rd printing ed. New York, NY: Holt, Henry

and Company; 1989

AVANÇOS TECNOLÓGICOS NOS

LABORATÓRIOS DE SONO

• Os primeiros registos de sono eram feitos em

equipamentos analógicos enormes, usando papel

onde os sinais eram inscritos por penas.

• O armazenamento do papel era difícil

• Estadiamento com a ajuda de tabelas e

calculadoras para obter índices, percentagens de

estadios, etc.

• O numero de canais era limitado e os sinais

tinham que ser muito bem selecionados

• Ao técnico era exigido não só o domínio dos

amplificadores mas também saber como

desentupir penas, carregar tinteiros, preparar

papel, sensores, etc.

AVANÇOS TECNOLÓGICOS NOS

LABORATÓRIOS DE SONO

COM BASE NO EEG, EOG E EMG:

Allan Rechtschaffen (Universidade de Chicago) e

Anthony kales (Los Angeles – Califórnia) em 1968, dando

continuidade às pesquisas extensivas acerca do sono e do seu

estadiamento, publicaram um pequeno manual com o objectivo

de clarificar e unificar tanto a terminologia como os critérios

usados por quem estadia o sono.

1968

2007

AS PATOLOGIAS DO SONO

EVOLUÇÃO DOS SENSORES

CARDIORESPIRATÓRIOS

EEG

EOG

EMGmento

Fluxo aéreo

Movimentos respiratórios

SaO2

SISTEMAS DE DIAGNÓSTICO NÍVEL

III

-Não estão indicados em doentes pouco sintomáticos

-Não indicados em doentes com outras co-morbilidades

Colocar registo embla

Embleta

THE

INTERNATIONAL CLASSIFICATION

OF

SLEEP DISORDERS, REVISED

Diagnostic and Coding Manual

Produced by the

American Academy of Sleep M edicine

in association with the

EUROPEAN SLEEP RESEARCH SOCIETY

JAPANESE SOCIETY OF SLEEP RESEARCH

LATIN AMERICAN SLEEP SOCIETY

SAS – PATOLOGIA ASSOCIADA

N = 1100

%

Management and medical staff The head of the SMC should have a permanent position at the institution in order to ensure continuity of medical care for patients with sleep disorders. An SMC must have a responsible physician (MD) who can demonstrate comprehensive knowledge of the diagnostic spectrum of sleep disorders. To be eligible for accreditation by the NSS, the applicant must be a member of the NSS and have, or will obtain, a National Board Certification of Sleep Medicine, if available.1

Medical emergency care must be guaranteed. In case of emergency, a physician must be available to attend the SMC, at clinically appropriate, short notice. Medical care must be ensured at all times: an attending physician in the clinic is considered sufficient. Overall, the staff policy of the hospital should ensure that the sleep laboratory is an independent entity; e.g. those nurses and technologists performing night duty in the sleep laboratory must not have any further responsibilities, such as night duty in another ward.

Technical staff The operation of an SMC with both day and night examinations and a sleep outpatient clinic with ambulatory diagnostics requires an adequate staff. Nurses and technologists must have sufficient knowledge of the diagnostic and therapeutic procedures, the polysomnographic measuring methods, the procedures performed during the day, as well as ambulatory measuring procedures. Polysomnography (PSG) technologists for nocturnal and diurnal recordings are required to ensure the proper, artefact-free functioning of the recording devices, to detect problems and resolve them. This makes their presence during the entire recording process an absolute necessity. They are also required to continuously monitor the patient’s vital signs and take appropriate measures in case of emergency. It is recommended that one member of the night staff is responsible for no more than four patients.

GUIDELINES FOR CERTIFICATION OF PROFESSIONALS IN SLEEP MEDICINE Medical sleep specialists The certificate intends to show that the named person is able to carry out the diagnosis and differential diagnosis of sleep- related diseases, as listed in ICSD-2 (Sateia, 2005), and their management. Non-medical sleep professionals with a university master degree The certificate intends to show that the named person is able to demonstrate knowledge of sleep-related diseases, as listed in CSD-2 (Sateia, 2005), and their management, especially in their field of competence (e.g., biology, psychology, etc.). Nurses and technologists The certificate intends to show that the named person has basic knowledge of the disorders listed in ICSD-2 (Sateia, 2005) and is able to carry out the organization, logistics, preparation, recording, observation, analysis, evaluation, and documenta- tion of polysomnography (PSG), and other investigations carried out in the SMC. The candidate is responsible for the correct instruction and care of the patients.

ELIGIBILITY TO SIT THE FIRST ESRS

SLEEP TECH EXAM IN TALLINN INCLUDES

ALL OF THE FOLLOWING:

1. Grandfather of the profession with 10 yrs

PSG experience

2. Leading/supervisory role in your sleep lab

3. Current membership of the ESRS.

ESRS Somnologist – Technologist Exam:

Tallinn 2014

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