Evaluación del impacto de la cirugía bariátrica sobre el índice de apneas-hipopneas del sueño (IAH)

Abstract

Introduction: OSA in a disease characterized by complete repetitive (apnea) or incomplete (hypopnea) collapse of the upper airway (UAO) while the patient is sleeping. The National Consensus Document on OSA defines it as a picture of excessive sleepiness, cognitive-behavioral, respiratory, cardiac, metabolic or inflammatory disorders secondary to repeated episodes of upper airway obstruction (UAO) during sleep. These episodes are measured with the apnea-hypopnea index (AHI). OSA is a very prevalent disease in the general population that can cause deterioration in the quality of life, hypertension, cardiovascular, cerebrovascular diseases, traffic accidents and is related to an excess of mortality. In addition, it has been shown that undiagnosed patients double the consumption of health resources with respect to those diagnosed and treated. Therefore, OSA is considered a public health problem of the first magnitude. Obesity is the risk factor that is most often associated with OSA. In patients with morbid obesity, a multidisciplinary follow-up should be performed and contemplate the possibility of bariatric surgery. Hypothesis: Bariatric surgery will have a positive impact on the reduction of AHI through the reduction of BMI and can be predicted by generating a mathematical formula. The decrease in AHI will be influenced by clinical, anthropometric and respiratory functional variables. Bariatric surgery would achieve an improvement in the comorbidities associated with patients with morbid obesity. Objectives: Main: To evaluate the impact of bariatric surgery on the rate of sleep apnea hypopnea (AHI). Secondary: Determine factors predictors of change of the AHI. To analyze the evolution of comorbidities associated with obesity after bariatric surgery. Determine a formula to predict the reduction of AHI after bariatric surgery. Material and methods: This is a descriptive study with analytical components, observational, with follow-up and retrospective carried out in the Reina Sofia University Hospital (Murcia). A total of 101 patients with a diagnosis of OSA and a history of bariatric surgery were included in the study. The inclusion and exclusion criteria were as follows: Diagnosis of OSA by polygraphic and / or polysomnographic study with an apnea-hypopnea index equal to or greater than 5 prior to the intervention of a bariatric surgery. Subject in which the existence of OSA is excluded through polygraphic and / or polysomnographic study in which the apnea-hypopnea index (AHI) is less than 5. Patients without polygraph and / or polysomnographic control study after bariatric surgery. Results: A total of 101 patients were included in the study of which 49 were women (48.5%) and 51 (51.5%) were men, with an average age of 45.38 ± 8.40 years. For the global sample, a descriptive study was carried out in which the quantitative variables were expressed by means, standard deviation and range and qualitative variables such as frequencies and percentages. The mean BMI values in women before and after the intervention were 47kg / m² and 29.29kg / m², respectively. In men, the previous BMI value was 45 kg / m² decreasing to 28.77 kg / m² posteriorly. No statistically significant differences were found between the reduction of BMI and the surgical technique used. The mean value of the AHI before CB was 39.85 / h (DS 24.55), while the AHI value after CB was 10.87 / h (DS 12.57), this difference being statistically significant (p <0.001). Conclusions: Bariatric surgery had a positive impact on the reduction of AHI, such that more than 88% of patients managed to reduce by one or more degrees with an average reduction of 29 events per hour at 2.3 years of age. The most important factor that was independently and significantly associated with the improvement of the AHI after bariatric surgery was the reduction in BMI and this can be predicted reliably by a mathematical formula. Age, sex, comorbidity, the type of surgery and anatomical factors such as the Mallampati grade did not contribute independently to the improvement of the AHI.Bariatric surgery was associated with an improvement of CT90%, mean oxygen saturation and remission of high blood pressure, type 2 diabetes mellitus and dyslipidemia. Bariatric surgery is an effective measure in reducing weight in patients with morbid obesity and contributes, in this way, to the clinical, metabolic and respiratory function improvement. All this strengthens and ratifies its use in these patients.