El Autor
J.F. Pagel, MD, MS, es profesor clínico asociado de medicina familiar en el programa
de residencia en medicina familiar de Colorado del Sur de la Escuela de medicina
de la Universidad de Colorado, en Pueblo, y director del Rocky Mountain Sleep
Disorders Center, en Pueblo y Colorado Springs, Colorado. El Dr. Pagel recibió su
título médico en la Universidad de Alabama en Birmingham, y culminó su residencia
en medicina familiar en el St. Mary’s Family Medicine Residency, en Grand
Junction, Colorado.
Dirija su correspondencia a J.F. Pagel, MD, MS, Rocky Mountain Sleep Disorders
Center, 1619 N. Greenwood St., Suite 206, Pueblo, CO 81003 (email: pueo34@juno.
com). No existen reimpresiones disponibles de parte de los autores.
Declaración del autor: Nada para declarar.
Figura 2. Algoritmo para el diagnóstico y el tratamiento de las condiciones que
causan somnolencia diurna excesiva.
(CPAP = presión positiva continua en la vía
aérea; OSA = apnea obstructiva del sueño.)
Diagnóstico y manejo de las condiciones que causan somnolencia diurna excesiva
* La consulta a medicina del sueño es necesaria por las pruebas de sueño en casa
de 2008 de los Centros de Servicio de Medicare
† Documentado por un seguimiento y una valoración objetiva de la utilización
de la CPAP (Tabla 3).
‡ Para pacientes con ocupaciones de alto riesgo en caso de somnolencia, como
los pilotos de aerolíneas.
REFERENCIAS
1. Johnson EO. Sleep in America: 2000. Results from the
National Sleep Foundation’s 2000 Omnibus sleep poll.
Washington, DC: The National Sleep Foundation; 2000.
http://www.sleepfoundation.org/atf/cf/{F6BF2668-
A1B4-4FE8-8D1A-A5D39340D9CB}/2000_poll.pdf.
Accessed October 28, 2008.
2. Friedman NS. Determinants and measurements of daytime
sleepiness. In: Pagel JF, Pandi-Perumal SR, eds.
Primary Care Sleep Medicine: A Practical Guide. Totowa,
N.J.: Humana Press; 2007:61-82.
3. Buysse DJ. Drugs affecting sleep, sleepiness, and performance.
In: Monk TH, ed. Sleep, Sleepiness, and Performance.
Chichester: Wiley; 1991:4-31.
4. National Sleep Foundation. State of the states report
on drowsy driving. November 2007. Available at
http://www.drowsydriving.org/ stateofthestatesreport.
Accessed October 17, 2008.
5. NTSB. Factors that affect fatigue in heavy truck accidents
safety study. Washington, DC: National Transportation
Safety Board; 1995.
6. Masa JF, Rubio M, Findley LJ. Habitually sleepy rivers
have a high frequency of automobile crashes associated
with respiratory disorders during sleep. Am J Respir
Crit Care Med. 2000;162(4 pt 1):1407-1412.
7. Pagel JF, Forister N, Kwiatkowki C. Adolescent sleep disturbance
and school performance: the confounding variable
of socioeconomics. J Clin Sleep Med. 2007;3(1):19-23.
8. Sforza E, de Saint Hilaire Z, Pelissolo A, Rochat T, Ibanez
V. Personality, anxiety and mood traits in patients with
sleep-related breathing disorders: effect of reduced
daytime alertness. Sleep Med. 2002;3(2):139-145.
9. Grunstein RR, Banerjee D. The case of “Judge Nodd”
and other sleeping judges—media, society, and judicial
sleepiness. Sleep. 2007; 30(5):625-632.
10. Chen I, Vorona R, Chiu R, Ware JC. A survey of subjective
sleepiness and consequences in attending physicians.
Behav Sleep Med. 2008;6(1):1-15.
11. American Academy of Sleep Medicine. The International
Classification of Sleep Disorders: Diagnostic &
Coding Manual. 2nd ed. Westchester, Ill.: American
Academy of Sleep Medicine; 2005.
12. Van Dongen H, Maislin G, Mullington JM, Dinges DF.
The cumulative cost of additional wakefulness: doseresponse
effects on neurobehavioral functions and
sleep physiology from chronic sleep restriction and total
sleep deprivation [published correction appears in
Sleep. 2004; 27(4):600]. Sleep. 2003;26(2):117-126.
13. Pagel JF. Sleep disorders in primary care: evidencebased
clinical practice. In: Pagel JF, Pandi-Perumal SR,
eds. Primary Care Sleep Medicine: A Practical Guide.
Totowa, N.J.: Humana Press; 2007:1-14.
14. Pagel JF. Medications that induce sleepiness. In: Lee-
Chiong TL, ed. Sleep: A Comprehensive Handbook.
Hoboken, N.J.: Wiley-Liss; 2006:175-182.
15. Sateia MJ, Doghramji K, Hauri PJ, Morin CM. Evaluation
of chronic insomnia. An Amerrican Academy of
Sleep Medicine review. Sleep. 2000;23(2):243-308.
16. Verster JC, Volkerts ER. Antihistamines and driving ability:
evidence from on-the-road driving studies during
normal traffic [published corrections appear in Ann
Allergy Asthma Immunol. 2004;92(6):675, and Ann
Allergy Asthma Immunol. 2005;94(3):409-410]. Ann
Allergy Asthma Immunol. 2004;92(3):294-303.
17. Young T, Evans L, Finn L, Palta M. Estimation of the clinically
diagnosed proportion of sleep apnea syndrome in middleaged
men and women. Sleep. 1997;20(9):705-706.
18. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive
sleep apnea: a population health perspective.
Am J Respir Crit Care Med. 2002;165(9):1217-1239.
19. World Health Organization. Obesity and overweight.
Fact sheet 311. September 2006. http://www.who.int/mediacentre/factsheets/fs311 /en/print.html. Accessed
October 27, 2008.
20. Sassani A, Findley LJ, Kryger M, Goldlust E, George C,
Davidson TM. Reducing motor-vehicle collisions, costs,
and fatalities by treating obstructive sleep apnea syndrome.
Sleep. 2004;27(3):453-458.
21. Findley LJ, Levinson MP, Bonnie RJ. Driving performance
and automobile accidents in patients with sleep apnea.
Clin Chest Med. 1992; 13(3):427-435.

