viernes, 2 de febrero de 2018

Apnea obstructiva del sueño / OSA

Febrero 2, 2018. No. 2982
Apnea obstructiva del sueño y el paciente bariátrico
OSA and the bariatric patient.
J Perioper Pract. 2017 Jul;27(7-8):167-168.
Mrs NH is a 49-year-old lady who presented for assessment prior to weight reduction surgery.
KEYWORDS: Bariatric surgery; OSA; Obstructive sleep apnoea; Pre-assessment
Identificación de la apnea obstructiva del sueño significativa en el paciente obeso: desarrollo de la nueva puntuación "DX-AOS".
Identification of significant obstructive sleep apnoea in the obese patient: development of the novel DX-OSA score.
Rom J Anaesth Intensive Care. 2016 Oct;23(2):111-121. doi: 10.21454/rjaic.7518/232.dxo.
BACKGROUND AND OBJECTIVES: There is a high prevalence of undiagnosed obstructive sleep apnoea (OSA) in obese surgical patients. We investigated the extent to which anthropometric measurements can be used to identify the presence of significant OSA (Apnoea/Hypopnoea Index (AHI) ≥ 20) in adult patients. MATERIALS AND METHODS: We prospectively studied 1357 adult patients scheduled for elective laparoscopic bariatric surgery. Prior to surgery, body mass index (BMI), gender, neck circumference, STOP-Bang score, SpO2, neck and trunk fat (by dual X-ray absorptiometry) were recorded. All patients with a STOP-Bang score ≥ 5 underwent polysomnography. Auto-titrated Positive Airway Pressure (APAP) therapy was instituted when AHI ≥ 20/h. Predictors of OSA were identified and their cut-off values determined. RESULTS: In total, 1357 patients were screened; 345 patients underwent preoperative polysomnography; 190 had AHI ≥ 20/h and received APAP treatment. The novel Dual X-Ray-Obstructive Sleep Apnoea (DX-OSA) score was derived from the data. The score included 6 items: the STOP-Bang score, BMI, neck fat, trunk fat, baseline SpO2, and Expiratory Reserve Volume (ERV), and its sensitivity, specificity, positive-predictive values, negative-predictive values, likelihood ratios, and post-test probabilities determined. At a cut-off of 3, the DX-OSA score had the same sensitivity as the STOP-bang score, but better specificity. The lowest likelihood ratio was found for STOP-Bang and the highest for the DX-OSA score (OSA probability > 83%). CONCLUSION: The DX-OSA score may be useful for identifying obese patients with significant OSA who require CPAP (continuous positive airway pressure) treatment, and CPAP could be commenced without the need for polysomnography, therefore, without delaying surgery.
KEYWORDS: continuous positive airway pressure; obesity; obstructive sleep apnoea
La mejoría temprana en la apnea obstructiva del sueño y el aumento en los niveles de orexina después de la cirugía bariátrica en adolescentes y adultos jóvenes.
Early improvement in obstructive sleep apnea and increase in orexin levels after bariatric surgery in adolescents and young adults.
Surg Obes Relat Dis. 2017 Jan;13(1):95-100. doi: 10.1016/j.soard.2016.05.023. Epub 2016 May 30.
BACKGROUND: Obstructive sleep apnea (OSA) associated with obesity is known to improve after bariatric surgery, but little is known about early changes in this condition after surgery. OBJECTIVES: To study the clinical course of OSA after bariatric surgery SETTING: Children's hospital in the United States METHODS: Adolescents and young adults with obstructive sleep apnea undergoing vertical sleeve gastrectomy (n = 6) or gastric bypass (n = 1) were enrolled in this prospective study. Participants underwent formal polysomnography before and at 3 and 5 weeks after bariatric surgery. Anthropometric measurements and assay for orexin and leptin were also performed at study visits. Thirty-one adolescents who underwent 2 polysomnography studies that were 4 weeks apart served as control patients. RESULTS: Baseline mean (range) age of participants was 17.8 (15.4-20.7) years, 71% were male, with body mass index of 55.2 (41.3-61.6) kg/m2 and had a median apnea hypopnea index (AHI) of 15.8 (7.1-23.8) events/hour. Differences in least-square means from longitudinal analysis did not show significant differences in AHI in the control group but showed significant postoperative decline in AHI relative to baseline. AHI declined postoperatively from baseline by 9.2 events/hour (95% confidence interval: 3.8 to 14.5) at 3 weeks (P = .002) and 9.1 events/hour (95% confidence interval: 3.8 to 14.5) at 5 weeks (P = .002); there was no significant change from 3 to 5 weeks in AHI. Leptin decreased and orexin levels increased significantly by 3 weeks postoperatively. CONCLUSIONS: These observations suggest that OSA responds early and out of proportion to weight loss after metabolic and or bariatric surgery, thus weight independent factors may at least in part be responsible for early improvement in OSA postoperatively.
KEYWORDS: Leptin; Orexin; Polysomnography; Sleep apnea; Sleeve gastrectomy
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