o passado aqui tão perto

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
Fluxo
aéreo
EOG
Movimentos
respiratórios
SaO2
EEG
EMGmento
SISTEMAS DE DIAGNÓSTICO NÍVEL
III
Embleta
Colocar registo embla
-Não estão indicados em doentes pouco sintomáticos
-Não indicados em doentes com outras co-morbilidades
THE
I NTERNATI ONAL CLASSI FI CATI ON
OF
SLEEP DI SORDERS, REVI SED
Diagnostic and Coding M anual
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 documentation 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
MUITO OBRIGADA