José Ignacio Marmolejo es kinesiólogo, docente universitario, magíster en gestión y diplomado de la medicina del sueño. Dirige el primer diplomado en Chile enfocado al manejo de Terapia Ventilatoria en Trastornos Respiratorios del Sueño y hoy saca una maestría en transformación digital para llevar a lo virtual su área de experiencia. Sin embargo, antes de cualquier otro título nobiliario, Marmolejo es un paciente de apnea del sueño severa. Usuario de CPAP, incluso, ya que carga con esta herencia congénita y familiar que lo ha llevado a tratarse, pero también a formarse en las posibilidades de tratamiento en un campo que, considera no ha sido lo suficientemente atendido.
“Yo sé que ronco desde siempre. Fue el año 2011 -a los 28 años- cuando me diagnosticaron apnea del sueño severa. Con un origen genético ya que mi familia sufre de una hipotonía en el tono muscular que hace que nuestra vía aérea se cierre al dormir independiente del peso que uno tenga y generando muchas pausas respiratorias durante el sueño, algo que afecta la calidad de vida actual y futura”, explica. Fue precisamente en este período en que Marmolejo empezó a transitar la ruta de las clínicas de sueño, especialistas y los exámenes donde se encontró con las problemáticas típicas de este tipo de diagnóstico: el difícil acceso a un examen la polisomnografía, lo complejo de dar con un buen especialista en medicina del sueño y la excesiva centralización de las clínicas del área. “Te vas dando cuenta del mar de dudas al que se enfrenta una persona golpeada por un diagnóstico que puede ser muy preocupante al inicio y donde la realidad geográfica tan dispar del país te juega en contra”, detalla Marmolejo.
Se refiere a las esperas de más de un año en la salud pública para conseguir una polisomnografía, por ejemplo. A la baja cantidad de médicos generales de zona con especialización en sueño y los pocos recursos para diagnosticar un síndrome de piernas inquietas, insomnio o apnea obstructiva del sueño al no contar con el equipamiento o centros médicos especializados en provincia, agrega. Con el tiempo, y ya como profesional y docente de la Facultad de Medicina de la Universidad del Desarrollo, comenzó a darle vueltas a una idea que podría revolucionar el tratamiento en un mercado en deuda con la salud del sueño, ya que en Chile existen 0.3 centros de sueño por cada 100 mil habitantes, cuando, según estándares internacionales, debería haber al menos 1 cada 100 mil.
Considerando que el costo de una polisomnografía es un factor relevante para quien se somete a una noche de cables y electrodos en una cama clínica, desde el punto de vista operativo, resulta un examen caro, difícil de implementar y, en pandemia, muy poco probable realizarlo. Marmolejo detalla que “se obtienen resultados más precisos realizando este mismo examen en casa ya que está documentado que ni siquiera una noche en un hotel 5 estrellas es garantía de un sueño normal, imagínate a una persona que ha esperado un año por su examen en un hospital público o que costearlo en la salud privada le significa un gasto importante. La ansiedad no lo dejará dormir con normalidad para que el examen resulte representativo”
En este contexto, el especialista se asoció con expertos a nivel internacional para crear el Centro Virtual del Sueño, un prestador de servicios de salud que prioriza la telemedicina y tecnologías remotas para el diagnóstico y tratamiento de los principales trastornos respiratorios del sueño. Marmolejo cuenta que el principal atributo de este centro es su alcance nacional a través de una red de atención que, con los insumos específicos, permite a médicos no especialistas abordar el diagnóstico inicial de enfermedades como la apnea del sueño. “Contamos con equipamiento móvil de última generación para que puedas realizar los exámenes en tu casa con un teléfono móvil y el dispositivo que te hacemos llegar que registra ronquidos, desaturación de oxígeno, movimientos, frecuencia cardíaca y otra información relevante. Esto, sumado a cuestionarios digitales permiten detectar otras patologías. Con este sistema hemos podido descubrir que personas muy jóvenes sufrían de narcolepsia, por ejemplo”, destaca el kinesiólogo sobre un sistema que, sumado a la asesoría médica y acompañamiento permanente, evita incurrir en traslados, hospitalización y gastos que, en el caso de una polisomnografía, pueden alcanzar el millón de pesos. Los exámenes equivalentes que ofrece Centro Virtual del Sueño rondea los 30 mil pesos y constan de diagnóstico simplificado, poligrafía respiratoria, autotitulación de CPAP y polisomnografías con centros en convenio.
“Nuestros exámenes no reemplazan una polisomnografía, pero son una respuesta proporcional a un problema clave. Si detectamos una parasomnia así de sencillamente, ¿para qué vamos a gastar en hospitalización en una clínica?. Por otro lado, si se detecta otra complejidad con este sistema, puedes ir con el especialista y seguir el tratamiento respectivo, pero con lo que te ahorraste en exámenes innecesarios ya puedes comprarte el CPAP”, explica el representante del Centro Virtual del Sueño.
Un recurso estratégico
Explica que cuando una persona llega a una consulta por apnea del sueño severa es porque ya es bastante tarde. “Ya tuviste un accidente laboral o te quedaste dormido al volante. No sabes porqué llevas tanto tiempo agotado y tu pareja está destruida por tu mal dormir y los ronquidos, etcétera. Lo que queremos hacer con esta plataforma es facilitar la atención primaria porque creemos que, muchas veces, lo perfecto es enemigo de lo bueno. Es decir, cuando quieres hacerte el mejor examen del sueño, lo mejor es pensar estratégicamente y redirigir tus recursos”. Plantea que, la idea es tender a una rentabilidad prudente para que el sistema de Isapres y Fonasa sumen garantías y prestaciones a pacientes de esta plataforma en un corto plazo.
La salud del sueño debería ser un tema de política pública de salud, sostiene Marmolejo. Cita un estudio de la Sociedad Americana del Sueño que informa que los pacientes de apnea del sueño sin tratar gastan, en promedio, 4 mil dólares más al año respecto de los que sí cuentan con un tratamiento. “Esto también ha sido asociado a otros costos de productividad cruzando el dato con conductores que tienen accidentes de tránsito, operadores de maquinaria pesada y otros puestos críticos. Imagina la importancia de un tratamiento eficaz para una persona que conduce vehículos en la minería, opera grúas o trabaja como operador aéreo… los costos muchas veces son más que plata, son vidas, son relaciones interpersonales, también”, reflexiona.
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i�ini bu kadar iyi yapan bir siteye denk gelmek �ok g�zel. Tebrikler ve ba�ar�lar dilerim!
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