{"id":13368,"date":"2023-10-18T10:35:06","date_gmt":"2023-10-18T10:35:06","guid":{"rendered":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/?p=13368"},"modified":"2023-10-18T10:35:10","modified_gmt":"2023-10-18T10:35:10","slug":"llr-policy-for-referral-for-obstruction-sleep-apnoea","status":"publish","type":"post","link":"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/pl\/llr-policy-for-referral-for-obstruction-sleep-apnoea\/","title":{"rendered":"Polityka LLR dotycz\u0105ca skierowa\u0144 z powodu obturacyjnego bezdechu sennego"},"content":{"rendered":"<p><\/p>\n\n\n\n<p><strong>Kategoria<\/strong><\/p>\n\n\n\n<p>Kryteria progowe<\/p>\n\n\n\n<p>Zesp\u00f3\u0142 obturacyjnego bezdechu\/sp\u0142yconego oddychania podczas snu (OSAHS) nale\u017cy do spektrum zaburze\u0144 oddychania podczas snu, kt\u00f3re obejmuje r\u00f3wnie\u017c zesp\u00f3\u0142 oporu g\u00f3rnych dr\u00f3g oddechowych i zwyk\u0142e chrapanie. OSAHS to nie tylko kwestia zak\u0142\u00f3cania snu partnera, ale tak\u017ce zaburzenia funkcjonowania w ci\u0105gu dnia, s\u0142ab\u0105 produktywno\u015b\u0107 w pracy, dra\u017cliwo\u015b\u0107, depresj\u0119 i utrat\u0119 libido. Powi\u0105zana senno\u015b\u0107 po przebudzeniu mo\u017ce prowadzi\u0107 do wypadk\u00f3w podczas prowadzenia pojazd\u00f3w lub obs\u0142ugiwania niebezpiecznych maszyn. Ponadto istnieje coraz wi\u0119cej dowod\u00f3w na zwi\u0105zek z zespo\u0142em metabolicznym, w tym oty\u0142o\u015bci\u0105, cukrzyc\u0105, nadci\u015bnieniem i zwi\u0119kszonym ryzykiem zawa\u0142u mi\u0119\u015bnia sercowego i udaru m\u00f3zgu. OSAHS ma konsekwencje dla kierowc\u00f3w, zar\u00f3wno posiadaczy prawa jazdy kategorii 1, jak i 2 (HGV, PSV).<strong><\/strong><\/p>\n\n\n\n<p><br>Pacjent\u00f3w, kt\u00f3rzy chrapi\u0105, nale\u017cy zbada\u0107 pod k\u0105tem prawdopodobie\u0144stwa wyst\u0105pienia OSAHS, co obejmuje wywiad i badanie przedmiotowe oraz wype\u0142nienie Kwestionariusza Berli\u0144skiego (w celu oceny ryzyka) i Skali Senno\u015bci Epworth (wska\u017anik upo\u015bledzenia funkcji w ci\u0105gu dnia).<\/p>\n\n\n\n<p>Kwestionariusz Berli\u0144ski dzieli pacjent\u00f3w na grupy wysokiego i niskiego ryzyka OSAHS. Sk\u0142ada si\u0119 z 3 domen; chrapanie, senno\u015b\u0107\/zm\u0119czenie i czynniki ryzyka. Pozytywna odpowied\u017a w 2 lub wi\u0119cej domenach wskazuje na wysokie ryzyko OSAHS. Pacjenci mog\u0105 potrzebowa\u0107 pomocy przy wype\u0142nianiu tego kwestionariusza, poniewa\u017c wymagane jest obliczenie BMI (patrz Za\u0142\u0105cznik 2, Kwestionariusz Berli\u0144ski).<\/p>\n\n\n\n<p>Wszyscy pacjenci podejrzeni o OSAHS powinni wype\u0142ni\u0107 kwestionariusz Epworth Score. Je\u015bli to mo\u017cliwe, ich partner powinien zosta\u0107 poproszony o wydanie drugiej opinii. Dzieje si\u0119 tak dlatego, \u017ce pacjenci nie zawsze w pe\u0142ni doceniaj\u0105 stopie\u0144, w jakim s\u0105 dotkni\u0119ci chorob\u0105 (patrz Za\u0142\u0105cznik 1, Skala Senno\u015bci Epworth). Ka\u017cde podwy\u017cszenie ESS ma wp\u0142yw na bezpiecze\u0144stwo pacjenta, oczekiwan\u0105 d\u0142ugo\u015b\u0107 \u017cycia i jako\u015b\u0107 \u017cycia. Je\u015bli nie da si\u0119 tego bezpo\u015brednio przypisa\u0107 zmniejszonej mo\u017cliwo\u015bci snu, wskazane mo\u017ce by\u0107 skierowanie do Centrum Snu.<\/p>\n\n\n\n<p>Pacjenci z prawid\u0142owym ESS i niskim ryzykiem w skali Berlin Score nie powinni zazwyczaj by\u0107 brani pod uwag\u0119 przy kierowaniu do o\u015brodka Sleep Service. Nale\u017cy im zapewni\u0107 (w stosownych przypadkach) porady i ulotki informacyjne na temat samodzielnego leczenia prostego chrapania, unikania stosowania \u015brodk\u00f3w uspokajaj\u0105cych i alkoholu, utraty wagi, rzucania palenia oraz stosowania urz\u0105dzenia do zmiany po\u0142o\u017cenia \u017cuchwy (MRD) lub szyny \u017cuchwy. Wszystkich takich pacjent\u00f3w nale\u017cy r\u00f3wnie\u017c ostrzec o niebezpiecze\u0144stwach zwi\u0105zanych z prowadzeniem pojazdu w stanie \u015bpi\u0105czki.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Uprawnienia<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>\u00a0<\/strong><br><strong>LLR ICB b\u0119dzie wspiera\u0107 kierowanie do Centrum Snu nast\u0119puj\u0105cych pacjent\u00f3w.<\/strong><br>\u00a0<br>Wszyscy pacjenci uznani w skali Berlin Score za \u201ewysokiego ryzyka\u201d powinni zosta\u0107 skierowani do Centrum Snu w celu dalszego zbadania i ewentualnego leczenia. Wysoki wynik Epworth wskazuje na upo\u015bledzenie funkcji w ci\u0105gu dnia i mo\u017ce sugerowa\u0107 pilniejsze skierowanie do lekarza.<br>\u00a0<br>Pilne skierowanie nale\u017cy rozwa\u017cy\u0107 w nast\u0119puj\u0105cych okoliczno\u015bciach:<br>\u00b7 Po\u0142\u0105czenie ci\u0119\u017ckiego OSAHS i POChP<br>\u00b7 Pacjenci z objawami sugeruj\u0105cymi OSAHS, kt\u00f3rzy s\u0105 senni podczas prowadzenia pojazd\u00f3w lub pracy z maszynami lub kt\u00f3rzy s\u0105 zatrudnieni w zawodach niebezpiecznych.<br>\u00b7 Pacjenci z objawami sugeruj\u0105cymi OSAHS i u kt\u00f3rych wyst\u0119puj\u0105 objawy niewydolno\u015bci oddechowej.<br>\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Przewodnictwo<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Johnsa MW. Nowa metoda pomiaru senno\u015bci w ci\u0105gu dnia: Skala Senno\u015bci Epworth. Sen 1991;14:540-5<br>\u00a0<br>Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Wykorzystanie Kwestionariusza Berli\u0144skiego do identyfikacji pacjent\u00f3w zagro\u017conych zespo\u0142em bezdechu sennego. Roczniki Chor\u00f3b Wewn\u0119trznych 1999; 131:485-91<br>\u00a0<br>Szkocka Mi\u0119dzyuczelniana Sie\u0107 Wytycznych (SIGN). Post\u0119powanie w przypadku obturacyjnego bezdechu sennego\/zespo\u0142u sp\u0142yconego oddychania u doros\u0142ych: krajowe wytyczne kliniczne. Wytyczne SIGN 73, 2003. www.sign.ac.ukLLR PCT dla UHL 0809 Sekcja kontraktu C4-4g Kwestionariusze PCT i skierowania dotycz\u0105ce chrapania v3 \u2013 0809.doc<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Data przegl\u0105du ARP 88: 2026 r<\/td><\/tr><\/tbody><\/table><\/figure>","protected":false},"excerpt":{"rendered":"<p>Category Threshold Criteria Obstructive Sleep Apnoea\/Hypopnoea Syndrome (OSAHS) is part of a spectrum of sleep disordered breathing that also includes upper airway resistance syndrome and simple snoring. More than just [&hellip;]<\/p>\n","protected":false},"author":542,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[57],"tags":[88,83],"class_list":["post-13368","post","type-post","status-publish","format-standard","hentry","category-policies","tag-sleep","tag-threshold"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>LLR Policy for Referral for Obstruction Sleep Apnoea - LLR ICB<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/leicesterleicestershireandrutland.icb.nhs.uk\/pl\/llr-policy-for-referral-for-obstruction-sleep-apnoea\/\" \/>\n<meta property=\"og:locale\" content=\"pl_PL\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"LLR Policy for Referral for Obstruction Sleep Apnoea - LLR ICB\" \/>\n<meta property=\"og:description\" content=\"Category Threshold Criteria Obstructive Sleep Apnoea\/Hypopnoea Syndrome (OSAHS) is part of a spectrum of sleep disordered breathing that also includes upper airway resistance syndrome and simple snoring. 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