Papel da gastroplastia no tratamento da apnéia obstrutiva durante o sono

Reimão, Rubens; Lemmi, Helio; Cowan, George; Golden, Emmel B.

doi:10.1590/S0004-282X1986000100004

Resumos

Gastroplastia foi realizada como forma terapêutica auxiliar para redução de peso em 4 pacientes com obesidade severa e apnéia obstrutiva durante o sono (ASO). As idades variavam de 31 a 54 anos e todos eram do sexo masculino. Em três casos a gastroplastia acompanhou-se de traqueostomia. Após a gastroplastia todos tiveram melhora da sonolência diurna e redução de peso em 16,7% a 40,9%. Avaliações polissonográficas de noite inteira realizadas no pré e pós-operatório (3-4 meses). Os registros pós-operatórios foram feitos com traqueostomia fechada e revelaram redução da freqüência das apnéias e aumento dos estágios 3, 4 e REM. Normalização dos índices de saturação arterial de oxigênio (Sa0(2)) foi constatada em três dos 4 casos. Esses dados sugerem que a gastroplastia pode ser utilizada como forma alternativa para redução de peso em casos selecionados de ASO complementando outros procedimentos cirúrgicos como a traqueostomia.

Four male obese patients with obstructive sleep apnea were evaluated by polysomnography, both prior and 3-4 months following gastroplasty. The surgery was performed as an alternative weight loss treatment. These patients were selected for gastroplasty because they had severe obesity, obstructive sleep apnea with cardiopulmonary impairment and noncompliance on a weight loss diet. Tracheostomy was performed concomitantly in three cases. Preoperative recording demonstrated 21.2 to 100.3 apneas per hour of sleep; stage 3 was decreased in three and absent in one case; stage 4 was absent in every patient; stage REM was decreased in three cases; arterial oxygen saturation (Sa0(2)) was below 80% in every case during apenas. Follow-up recordings with occluded tracheostomy were obtained 3-4 months after surgery. The weight reduction varied from 16.3 to 41.4% of the initial weight. The recording documented normal sleep apnea indices in three cases and partial recovery in the remainder; increase in stages 3, 4 and REM; normal Sa0(2) in three out of 4 cases. These findings suggest that gastroplasty may be used as an alternative treatment for weight reduction in selected OSA patients.

Rubens Reimão^I; Helio Lemmi^II; George Cowan^III; Emmel B. Golden^IV

^INeurologista - Trabalho do Department of Neurodiagnostics, Baptist Memorial Hospital (BMH), Memphis, Tennessee, E.U.A.

^IIProfessor de Neurologia, University of Tennessee - Trabalho do Department of Neurodiagnostics, Baptist Memorial Hospital (BMH), Memphis, Tennessee, E.U.A.

^IIICirurgião BMH - Trabalho do Department of Neurodiagnostics, Baptist Memorial Hospital (BMH), Memphis, Tennessee, E.U.A.

^IVPneumologista BMH. Bolsa CAPES 3502/82-3 - Trabalho do Department of Neurodiagnostics, Baptist Memorial Hospital (BMH), Memphis, Tennessee, E.U.A.

RESUMO

Gastroplastia foi realizada como forma terapêutica auxiliar para redução de peso em 4 pacientes com obesidade severa e apnéia obstrutiva durante o sono (ASO). As idades variavam de 31 a 54 anos e todos eram do sexo masculino. Em três casos a gastroplastia acompanhou-se de traqueostomia. Após a gastroplastia todos tiveram melhora da sonolência diurna e redução de peso em 16,7% a 40,9%. Avaliações polissonográficas de noite inteira realizadas no pré e pós-operatório (3-4 meses). Os registros pós-operatórios foram feitos com traqueostomia fechada e revelaram redução da freqüência das apnéias e aumento dos estágios 3, 4 e REM. Normalização dos índices de saturação arterial de oxigênio (Sa0₂) foi constatada em três dos 4 casos. Esses dados sugerem que a gastroplastia pode ser utilizada como forma alternativa para redução de peso em casos selecionados de ASO complementando outros procedimentos cirúrgicos como a traqueostomia.

SUMMARY

Four male obese patients with obstructive sleep apnea were evaluated by polysomnography, both prior and 3-4 months following gastroplasty. The surgery was performed as an alternative weight loss treatment. These patients were selected for gastroplasty because they had severe obesity, obstructive sleep apnea with cardiopulmonary impairment and noncompliance on a weight loss diet. Tracheostomy was performed concomitantly in three cases. Preoperative recording demonstrated 21.2 to 100.3 apneas per hour of sleep; stage 3 was decreased in three and absent in one case; stage 4 was absent in every patient; stage REM was decreased in three cases; arterial oxygen saturation (Sa0₂) was below 80% in every case during apenas. Follow-up recordings with occluded tracheostomy were obtained 3-4 months after surgery. The weight reduction varied from 16.3 to 41.4% of the initial weight. The recording documented normal sleep apnea indices in three cases and partial recovery in the remainder; increase in stages 3, 4 and REM; normal Sa0₂ in three out of 4 cases. These findings suggest that gastroplasty may be used as an alternative treatment for weight reduction in selected OSA patients.

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Sleep Disorders Center, Ncurodiagnostics Department, Baptist Memorial Hospital - 899 Madison Avenue - Memphis 38146 - U.S.A.

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