Impacto imediato da cirurgia de via aérea superior nos parâmetros respiratórios em adultos com apneia obstrutiva do sono

• Ano de defesa: 2018
• Autor(a) principal: Stefanini, Renato [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Superior airway; Respiratory parameters; Obstructive sleep apnea; I Via aérea superior parâmetros respiratórios; Apneia obstrutiva do sono
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6486119; https://repositorio.unifesp.br/handle/11600/52792

Introduction: One of the concerns regarding the surgical treatment of obstructive sleep apnea syndrome (OSAS) has been the possibility that these patients may present with perioperative complications, which could be aggravated due to upper airway (UA) edema. Thus, there is a need for studies that evaluate the real impact of UA surgery, especially the pharyngeal surgery, on the respiratory parameters routinely presented by these patients. Objectives: To evaluate the immediate impact of pharyngeal surgery on the respiratory parameters of adult patients with OSAS. To compare the results obtained in the immediate postoperative period (IPO) of the pharyngeal surgery with the results of the evaluation after a minimum period of 3 months of treatment (late postoperative period LPO). Method: Twentythree adults with moderate to severe OSAS and with indication for pharyngeal surgery (with or without nasal surgery), were consecutively selected. The subjects were submitted to questionnaires, physical examination and anthropometric evaluation, surgical treatment and monitoring of preoperative sleep parameters (polysomnography type 1 PSG), IPO (arterial tonometry) and LPO (PSG and arterial tonometry). Results: 22 subjects were included in the study and 17 returned to the evaluation in the LPO. In the comparison between preoperative PSG and arterial tonometry in the IPO, there was a reduction in apnea and hypopnea index (AHI) (p = 0.03), respiratory disturbance index (RDI) (p = 0.05) and oxygen desaturation index (ODI) (p = 0.001), and there was an increase in the oxyhemoglobin saturation (SpO2) nadir (p = 0.003) and the percentage of REM sleep (p = 0.01). The comparison between preoperative PSG and LPO PSG shows a significant reduction of AHI (p <0.001), RDI (p <0.001) and ODI (p = 0.009); and increase of SpO2 nadir (p = 0.002). In the comparison between the arterial tonometry of the IPO and the LPO, there was a significant reduction of the AHI (p = 0.01), the RDI (p = 0.02) and the percent of sleep time below SpO2 90% (tSpO2 <90%) (p = 0.01), and a significant increase in REM sleep percentage (p <0.001). There was no statistically significant difference in AHI, RDI and tSpO2 <90% in the comparison between arterial tonometry and PSG in LPO, but the SpO2 nadir was lower in PSG (p = 0.003). In the general comparison of preoperative, IPO and LPO data, there was a progressive decrease in AHI, RDI and tSpO2 <90% and a progressive increase in SpO2 nadir. There was a significant positive correlation (r = 0.88, p <0.001) between AHI of arterial tonometry and PSG in LPO. Conclusions: There was an improvement in respiratory parameters in the POI of patients with moderate and severe OSAS undergoing pharyngeal surgery. The improvement of the respiratory parameters was progressive over time, when the preoperative, POI and POT exams were compared.