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Dr. Ricardo Bello Carrera explains the importance of non-invasive mechanical ventilation for sleep disorders in an interview with Neurovirtual

September 9, 2019

capa entrevista

NN: Dr. Bello, could you please introduce yourself and tell us about your professional and academic career?
I am a pulmonologist specializing in sleep disorders. I want to focus during this interview on explaining further about the training of specialists on sleep disorders. The first approach in general medicine is not that much different than the relationship there is with other specialist fields.
I majored in pulmonology at the Medical Center La Raza of the Mexican Institution for Social Welfare. I then majored in respiratory sleep disorders at the National Institution of Respiratory Conditions. Dr. Ismael Cosio Villegas, also in Mexico City, was actually there where I trained on sleep disorders. After that, I completed a master’s degree in hospital administration, something totally independent from my main focus, but the target of this interview is to discuss sleep respiratory disorders.

NN: You graduated as a general practitioner, then majored in pulmonology and sleep medicine. Are there treatments for sleep disorders which require non-invasive mechanical ventilation?
Indeed. That´s the focus of my major. There is a variety of sleep disorders that are heterogeneous, and many specialists are involved. A pulmonologist involved in treating sleep disorders understands the patient should be ventilated, and they require non-invasive mechanical ventilation. Sleep disorders are diverse. The ones seen most often, are sleep apnea disorders, but there are also other disorders such as central apnea-related disorders, sleep-related hypoventilation syndromes, which are often linked to obesity, sleep-related hypoxemia, patients who suffer from neuromuscular chronic conditions, patients with Chronic Obstructive Pulmonary Disease, and patients with pulmonary fibrosis. All of them require, besides the polysomnographic tests, non-invasive ventilation treatment, which is, in fact, our forte. Some of our other colleagues treat it as well, but all in all, we are the ones in charge of following up and providing ventilation as needed.

NN: What is most frequently seen in clinical practice as far as obstructive sleep apnea?
The classic example is an adult, obese male patient who snores, and stops breathing. These patients never come by themselves, oddly enough, they are brought in for consultation by their wives, and in the case of women, they are generally brought in by their husbands, complaining their spouse is not sleeping well, and are making too much noise. Their snoring is intense and pauses during respiration and become more and more frequent and serious, also something that calls their attention is that the patient is out of breath. If we don´t treat these patients, and tend to their diagnosis, they are facing many risks and complications. One of the highest risks to these patients is the fact that they have more car accidents. Patients who have trouble sleeping and do not have a good nights rest and may not be breathing correctly contribute to more frequent car accidents. The other important issue these patients face is they remain untreated, and this leads to a higher risk of heart problems, principally heart or cerebral infarction.
“How many car accidents are caused by patients who have trouble sleeping because that patient is neither having a good rest nor breathing correctly?…”

NN: Talking of respiratory disorders, are all respiratory disorders connected to sleep alterations or difficulty sleeping?
The main symptom, or the reason for consultation on a daily basis, is excessive daytime sleepiness. Every patient, at some point during their disease, are going to complain of falling asleep during the day, even during risky situations. We have patients who fall asleep at work, while they are driving, when giving a lecture, or when receiving one. This is also common. The truth is that these are incapacitating conditions, and if they are not treated, patients and their work life, are going to be seriously affected. Once the treatment is started, the one corresponding to the patient´s age group, sleepiness improves, and patients are more productive, and their performance in daily activities improves, this is why physicians need to focus on referring patients on time, with the correct diagnosis and corresponding treatment.

NN: Do you think ambulatory polysomnographic tests can substitute a test conducted in the lab?
This is a very interesting and complex question. The truth is, polysomnography will continue being the golden standard until we have something better, however, ambulatory tests provide us with many possibilities, in particular, they reduce costs. Some patients cannot sleep in a place other than home. They need specific conditions to be able to rest, have their own bed, their own pillow, their clothing, their regular life conditions, and their family. This leads us to request ambulatory tests, or even, we suggest them ourselves. There will be a point when the quality of ambulatory tests is going to be as good as a test conducted in the lab, with some limitations still, such as the video, which we can have in the lab as such, or non-invasive ventilation as we were discussing earlier, however, as long as we don´t have access to a higher quality test, a test of higher clinical importance, we will need to continue relying on polysomnography, and additional ambulatory testing conducted by an expert technician can be as good as a classic polysomnographic test.
“Polysomnography will continue being the golden standard until we have something better.”

NN: In general, I would like to ask, how has your experience been with Neurovirtual?
I can´t help smiling every time I hear the name of the company because the first experience in my private practice was precisely with your devices, something that impressed me, because that is always nice, to be impressed in a positive way, not to suffer with technical support anymore. The problem in public hospitals is that when you require assistance with your equipment, maintenance, or when you simply have a problem you can´t solve at that moment, it is important that someone has your back. Sometimes receiving supplies takes several days or weeks, something that complicates things more, and at the end of the day, you end up solving it yourself, and in a very improvised way. This does not happen with Neurovirtual. With Neurovirtual, what we have seen is that when we have a problem, even during the night shift, we can call on the phone and a customer assistant gives us support and solves the problem. Another great advantage of the brand is that devices are portable. Classic equipment, besides being very big and very complex, have a very difficult software to handle. Neurovirtual offers accessible, user-friendly software, and I think, at some point, they will be easier to handle by trained staff. Of course, I think the possibilities of growth for the company are going to be immense. I predict lots of success because I believe you have approached the clinical component of the trade, not only the commercial one.
“If I had at hand the task of building a wing on the hospital, an area for my practice, and I needed to buy equipment, I would resort to your brand again.”

NN: Would you recommend Neurovirtual to other colleagues and sleep medicine specialists?
Of course! The first problem we face when we complete our studies, any major medical, is that when we start to build our practice, and start buying supplies, we have visits from representatives of every brand, and they tell us their products are the best. The truth is we need to choose. Fortunately, I was lucky enough to receive a recommendation about the Neurovirtual brand. I received it from professionals who are working in the sleep medicine field, and who have already worked with these devices. The truth is, I only had to contact your staff, and they were in charge of installing the equipment, solving any technical doubts we had, and trained my staff so they could use the software. To sum it up, they made the process easy for me. if I had at hand the task of building a wing on the hospital, an area for my practice, and I needed to buy equipment, I would resort to your brand again.
et ahead.

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