Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by successive episodes of cessation or decrease in respiratory airflow, in which obesity is an important risk factor. The prevalence of the disease in morbidly obese patients is approximately 70%. Treatment is based on the use of continuous positive airway pressure (CPAP) and weight loss in obese patients. Weight loss by dieting often produces unsatisfactory results, and the use of CPAP does not show good adherence because of being long-term and uncomfortable. Bariatric surgery has emerged as the treatment for morbid obesity and various associated co-morbidities. This article reviews the principal studies that evaluate the modifications in obstructive sleep apnea after bariatric surgery, showing that surgery is an effective treatment for the management of OSAHS in morbidly obese patients.
Background: Weight loss has been shown effective in the treatment of the obstructive sleep apnea-hypopnea syndrome. Regrettably, many obese patients are unable to achieve sustained and useful weight loss by dietary means. Recently, bariatric surgery has emerged as an alternative to treat obesity and many of its comorbidities, although its role for sleep apnea treatment is still not defined. Objectives: To evaluate the impact of bariatric surgery on obstructive sleep apnea in morbidly obese patients. Methods: In this cohort study, polysomnography, Epworth Sleepiness Scale questionnaire and clinical assessment were performed in 12 of 13 morbidly obese patients with moderate to severe obstructive sleep apnea treated with bariatric surgery through Roux-en-Y gastric bypass procedure after a minimum of 18 months post surgery. Results: The mean (±SD) loss of excess body weight was 70.5 ± 24%. The mean level obtained in the Epworth Scale was 4.8. There was a significant reduction in the apnea-hypopnea index, from a median of 46.5 (range: 33–140) to 16 (range: 0.9–87) events per hour (p < 0.05), an improvement in mean oxygen saturation from 85.7 ± 5.1 to 94.5 ± 3.6% (p < 0.05) and in minimum oxygen saturation from 64.7 ± 13.4 to 78.7 ± 13.7% (p < 0.05). The magnitude of the weight loss and the improvements in mean and minimum oxygen saturation were positively correlated, (r = 0.76; p ≤ 0.05, and r = 0.59; p ≤ 0.05, respectively). Conclusions: Weight loss achieved by bariatric surgery is associated with significant long-term improvements in obstructive respiratory event, oxygenation and resolution of daytime somnolence.
OBJETIVO: Estimar a prevalência de ronco habitual e apnéia obstrutiva observada e fatores associados. MÉTODOS:Estudo transversal com amostra representativa de 3.136 adultos, com 20 anos ou mais, residentes em Pelotas, Rio Grande do Sul, em 2005. Informações sobre os desfechos e variáveis demográfi cas, socioeconômicas, comportamentais e antropométricas foram coletadas por meio de questionário. A análise estatística bruta e ajustada foi realizada utilizando-se teste exato de Fisher ou qui-quadrado de tendência linear e regressão de Poisson, respectivamente. RESULTADOS:A prevalência encontrada de ronco habitual foi de 50,5% (IC 95%: 48,1;52,8) e de apnéia obstrutiva de 9,9% (IC 95%: 8,7;11,2). Na análise ajustada, o relato de ronco foi maior nos homens (Razão de Prevalências -RP=1,25; IC 95%: 1,16;1,34), nos idosos (RP=1,62; IC 95%: 1,46;1,80), nos tabagistas (RP=1,15; IC 95%: 1,07;1,25), nos alcoolistas (RP=1,17; IC 95%: 1,03;1,31) e nos obesos (RP 1,71, IC95% 1,55;1,88). O relato de apnéia obstrutiva foi maior nos homens (RP=2,05; IC 95%: 1,67;2,52), nos idosos (RP=2,23; IC 95%: 1,64;3,03), nos tabagistas (RP=1,60; IC 95%: 1,25;2,05) e nos obesos (RP=2,61; IC 95%: 1,97;3,47). CONCLUSÕES:Ronco habitual e apnéia obstrutiva foram sintomas comuns na população estudada. Fatores de risco conhecidos como sexo masculino e idade entre quarta e quinta décadas de vida não são modifi cáveis. Entretanto, tabagismo, alcoolismo e obesidade também associados aos desfechos, devem ser identifi cados e tratados na população geral. DESCRITORES: Síndromes da
Objective: to describe indications and results of supraglottoplasty for severe laryngomalacia in children with or without neurological impairment. Methods: eight children with severe laryngomalacia submitted to endoscopic supraglottoplasty were retrospectively studied. Four had neurological impairment (male, mean age 6 years), and 4 did not present neurological problems (3 female, mean age 11.5 months). Surgery indications were respiratory distress, feeding difficulties, failure to thrive, and low oxygen saturation. Polysomnographic evaluation was carried out on the last 2 children, showing abnormal oxygen saturation, obstructive apnea, and hypoventilation. All children received preoperative antibiotics and corticosteroids. Results: all children without neurological impairment had significant relief of symptoms. Children with neurological impairment had different outcome: one needed tracheotomy immediately after surgery due to edema and supraglottic granulation tissue. The other three children presented initial relief of symptoms, but subsequent follow-up showed progressive airway obstruction: one needed another endoscopic surgery 6 months later; other needed tracheotomy 7 months later. The children who were not submitted to tracheostomy presented persistent severe airway obstruction. No endoscopic surgery complication was observed. Conclusions: 1) Endoscopic supraglottoplasty is well tolerated and does not present complications when used in children; 2) Endoscopic supraglottoplasty was efficient in the treatment of children with severe laryngomalacia and in without neurological impairment; however, supraglottoplasty did not resolve airway obstruction in children with neurological impairment.
Objetivo: Este artigo tem por finalidade apresentar uma sucinta revisão sobre as repercussões da sonolência excessiva no desempenho dos motoristas no trânsito, enfatizando a necessidade da maior valorização do tema abordado. Métodos: Revisão bibliográfica da literatura nacional e internacional, abrangendo artigos originais e publicações oficiais da American Thoracic Society e da American Sleep Apnea Association. Resultados: As evidências de que a sonolência é um fator que pode contribuir de forma decisiva para a ocorrência de acidentes automobilísticos são crescentes. As dificuldades com relação à caracterização da sonolência precedendo o acidente são discutidas no texto. Muitas são as causas de sonolência excessiva; felizmente, sua maioria é passível de identificação e manejo adequado. Conclusões: É importante que haja maior entendimento do problema em nosso meio, para que possam ocorrer modificações na abordagem do paciente com sonolência excessiva e também discussões acerca das leis de trânsito vigentes e das obrigações legais do médico com relação a este problema.
ResumoObjetivos: descrever as indicações e resultados da supraglotoplastia endoscópica em crianças com e sem lesão neurológica que apresentavam laringomalacia grave.Métodos: estudo retrospectivo de 8 crianças com laringomalacia grave submetidas a supraglotoplastia endoscópica com material de microcirurgia. Quatro crianças tinham paralisia cerebral (todas masculinas, idade média 6 anos) e 4 eram crianças sem doença neurológica (3 femininas, idade média de 11,5 meses). As indicações da cirurgia foram dificuldade respiratória em repouso e/ou esforço, dificuldade de deglutição, deficiência de crescimento e baixa saturação transcutânea de oxigênio. Estudo polissonográfico realizado nas últimas duas crianças mostrou dessaturação na oximetria, apnéia e hipoventilação durante o sono. As crianças receberam corticóide e antibiótico no pré-operatório.Resultados: todas as crianças sem doença neurológica apresentaram melhora significativa do estridor e da obstrução ventilatória. Das crianças com paralisia cerebral, uma necessitou traqueostomia logo após a cirurgia por edema e tecido de granulação supraglótico. As outras três apresentaram melhora clínica inicial, mas pioraram progressivamente, apesar da realização de outros procedimentos: uma necessitou nova supraglotoplastia após 6 meses; outra necessitou traqueostomia após 7 meses. Aquelas sem traqueostomia persistem com obstrução ventilatória grave. Não foi observada complicação do procedimento cirúrgico.Conclusões: 1) a supraglotoplastia é bem tolerada e sem complicações na criança; 2) a supraglotoplastia, neste estudo, mostrouse eficaz no tratamento da laringomalacia grave em crianças sem paralisia cerebral; entretanto, a supraglotoplastia não melhorou a obstrução ventilatória de crianças com paralisia cerebral e laringomalacia grave. AbstractObjective: to describe indications and results of supraglottoplasty for severe laryngomalacia in children with or without neurological impairment.Methods: eight children with severe laryngomalacia submitted to endoscopic supraglottoplasty were retrospectively studied. Four had neurological impairment (male, mean age 6 years), and 4 did not present neurological problems (3 female, mean age 11.5 months). Surgery indications were respiratory distress, feeding difficulties, failure to thrive, and low oxygen saturation. Polysomnographic evaluation was carried out on the last 2 children, showing abnormal oxygen saturation, obstructive apnea, and hypoventilation. All children received preoperative antibiotics and corticosteroids.Results: all children without neurological impairment had significant relief of symptoms. Children with neurological impairment had different outcome: one needed tracheotomy immediately after surgery due to edema and supraglottic granulation tissue. The other three children presented initial relief of symptoms, but subsequent follow-up showed progressive airway obstruction: one needed another endoscopic surgery 6 months later; other needed tracheotomy 7 months later. The children who were not submitted to tracheos...
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