Faringoplastia lateral: resultados polissonográficos baseados em análise fenotípica da apneia obstrutiva do sono
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Pontifícia Universidade Católica de Campinas (PUC-Campinas)
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Introdução: Entre os tratamentos cirúrgicos para Apneia Obstrutiva do Sono (AOS),
a Faringoplastia Lateral (FL) vem apresentando resultados promissores na melhora
dos sintomas dessa doença. Contudo, a seleção de pacientes para FL continua sendo
um desafio. O estudo dos fenótipos da AOS tenta explicar a fisiopatologia dessa
doença e melhorar a seleção dos pacientes. Existem poucas publicações relatando
os resultados polissonográficos (PSG) da FL e não há publicação relacionando o
aspecto fenotípico com o resultado desta cirurgia. Objetivos: Avaliar os resultados
da FL e verificar se perfil fenotípico do paciente com AOS sãos preditivos de sucesso
cirúrgico. Método: Estudo observacional, prospectivo, transversal, com análise do
resultado da PSG realizada antes e após cirurgia de 46 pacientes submetidos a FL.
Para determinarmos os fenótipos, usamos as seguintes variáveis de interesse: índice
de apneia e hipopneia (IAH) em sono REM (IAHrem; fenótipo anatômico);
porcentagem de hipopneias em relação aos eventos respiratórios (fenótipo limiar de
despertar); número total de eventos respiratórios centrais ou mistos (fenótipo controle
respiratório) e a razão de eventos respiratórios em sono REM e sono Não REM
(fenótipo controle muscular). Resultados: Houve diferenças significantes antes e
após a cirurgia nos seguintes valores: IAH de 37,53 (20,82; 49,65) para 10,25 (2,27;
33,00) com p < 0,001. Saturação de Oxi-hemoglobina mínima de 77,98 ±10,88 para
82,78± 8,03 com p=0,008. O Tempo de saturação inferior a 90% de 3,55 minutos
(0,50; 9,05) para 0,00 (0,00; 1,50) com p=0,031. O IAMrem inferior a 20 eventos/hora
apresentou correlação positiva com o desfecho de sucesso, quando comparados a
pacientes com os pacientes com IAHrem de 20 ou mais eventos/hora (p=0,027) e
IAHrem maior do que 50 eventos/hora (p=0,041). Conclusão: A FL é uma cirurgia
eficiente para o tratamento da AOS, promovendo a redução estatisticamente
significante do IAH, com melhora da saturação de oxi-hemoglobina e do índice de
despertar. O IAHrem (fenótipo anatômico) mostrou-se indicativo de sucesso cirúrgico
quando seu valor é inferior a 20 eventos/hora de sono. As demais variáveis de
interesse para determinação dos fenótipos não se mostraram preditoras do sucesso
cirúrgico.
Introduction: Among the surgical treatments for Obstructive Sleep Apnea (OSA), Lateral Pharyngoplasty (LP) has shown promising results in improving the symptoms of this disease. However, patient selection for LP remains a challenge. The study of OSA phenotypes attempts to explain the pathophysiology of this disease and improve patient selection. There are few publications reporting the polysomnographic (PSG) results of LP and there is no publication relating the phenotypic aspect with the result of this surgery. Objectives: To evaluate the results of LP and verify if the phenotypic profile of the patient with OSA is predictive of surgical success. Method: Observational, prospective, cross-sectional study with analysis of PSG results performed before and after surgery in 46 patients underwent LP. To determine the phenotypes, we used the following variables of interest: apnea hypopnea index (AHI) in REM sleep (AHIrem; anatomical phenotype); percentage of hypopneas in relation to respiratory events (arousal threshold phenotype); total number of central or mixed respiratory events (respiratory control phenotype) and the ratio of respiratory events in REM sleep and Non-REM sleep (muscle control phenotype). Results: There were significant differences before and after surgery in the following values: AHI from 37.53 (20.82; 49.65) to 10.25 (2.27; 33.00) with p < 0.001. Minimum SatO2 from 77.98 ± 10.88 to 82.78 ± 8.03 with p=0.008. T<90% from 3.55 (0.50; 9.05) to 0.00 (0.00; 1.50) with p=0.031. A AHIrem of less than 20 events/hour showed a positive correlation with the outcome of success, when compared to patients with patients with a rem AHI of 20 or more events/hour (p=0.027) and a AHIrem greater than 50 events/hour (p= 0.041). Conclusion: LP is an efficient surgery for the treatment of OSA, promoting a statistically significant reduction in the AHI, with an improvement in oxyhemoglobin saturation and in the arousal index. The AHIrem (anatomical phenotype) was shown to be indicative of surgical success when its value is less than 20 events/hour of sleep. The other variables of interest for determining the phenotypes were not predictors of surgical success.
Introduction: Among the surgical treatments for Obstructive Sleep Apnea (OSA), Lateral Pharyngoplasty (LP) has shown promising results in improving the symptoms of this disease. However, patient selection for LP remains a challenge. The study of OSA phenotypes attempts to explain the pathophysiology of this disease and improve patient selection. There are few publications reporting the polysomnographic (PSG) results of LP and there is no publication relating the phenotypic aspect with the result of this surgery. Objectives: To evaluate the results of LP and verify if the phenotypic profile of the patient with OSA is predictive of surgical success. Method: Observational, prospective, cross-sectional study with analysis of PSG results performed before and after surgery in 46 patients underwent LP. To determine the phenotypes, we used the following variables of interest: apnea hypopnea index (AHI) in REM sleep (AHIrem; anatomical phenotype); percentage of hypopneas in relation to respiratory events (arousal threshold phenotype); total number of central or mixed respiratory events (respiratory control phenotype) and the ratio of respiratory events in REM sleep and Non-REM sleep (muscle control phenotype). Results: There were significant differences before and after surgery in the following values: AHI from 37.53 (20.82; 49.65) to 10.25 (2.27; 33.00) with p < 0.001. Minimum SatO2 from 77.98 ± 10.88 to 82.78 ± 8.03 with p=0.008. T<90% from 3.55 (0.50; 9.05) to 0.00 (0.00; 1.50) with p=0.031. A AHIrem of less than 20 events/hour showed a positive correlation with the outcome of success, when compared to patients with patients with a rem AHI of 20 or more events/hour (p=0.027) and a AHIrem greater than 50 events/hour (p= 0.041). Conclusion: LP is an efficient surgery for the treatment of OSA, promoting a statistically significant reduction in the AHI, with an improvement in oxyhemoglobin saturation and in the arousal index. The AHIrem (anatomical phenotype) was shown to be indicative of surgical success when its value is less than 20 events/hour of sleep. The other variables of interest for determining the phenotypes were not predictors of surgical success.