Covarrubias-Gómez A, Guevara-López U, Haro-Valencia R, Alvarado-Suárez M

Idioma: Español
Referencias bibliográficas: 38
Paginas: 371-380
Archivo PDF: 165.68 Kb.

RESUMEN

El síndrome de apnea obstructiva del sueño es una entidad frecuente en la población general y forma parte de las alteraciones respiratorias asociadas con dormir. Esta alteración ocurre durante las distintas etapas del sueño y con mayor intensidad en el sueño de movimientos oculares rápidos, posiblemente debido a que en esta etapa se presenta atonía muscular generalizada, inclu-yendo los músculos de la hipofaringe, lo que favorece la reducción del calibre de la vía aérea superior, dificultad para el flujo de aire y la obstrucción mecánica. Debido a que los pacientes con síndrome de apnea obstructiva del sueño tienen el riesgo de presentar dificultad para la intubación/ventilación, hipoxia e hipercapnia durante la ventilación espontánea o asistida y posibles complicaciones cardiovasculares, se ha considerado que la presencia del síndrome incrementa la morbilidad y mortalidad perio-peratoria, por lo que resulta conveniente la detección oportuna. Con base en lo anterior nos propusimos revisar el impacto que tiene este síndrome en los pacientes a quienes se aplicará un procedimiento anestésico-quirúrgico, cómo incrementa el riesgo perioperatorio y la ventaja de identificarlo y evaluarlo durante la valoración preanestésica.

REFERENCIAS (EN ESTE ARTÍCULO)

1. 1. Den Herden C, Schmeck J, Appelboom DJK, De Vries N. Risks of general anesthesia in people with obstructive sleep apnoea. BJM 2004;329:955-953.

2. 2. Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 2004;79:1036-1046.

3. 3. Hirshkowitz M. Normal human sleep: an overview. Med Clin North Am 2004;88:551-565.

4. 4. Strohl KP, Cherniack NS, Gothe B. Physiologic basis of therapy for sleep apnea. Am Rev Respir Dis 1986;134:791-802.

5. 5. Hudgel DW. Variable site of airway narrowing among obstructive sleep apnea patients. J Appl Physiol 1986;61:1403-1409.

6. 6. Pashayan A, Passannante AN, Rock P. Patho-physiology of obstructive sleep apnea. Anesthesiol Clin North Am 2005;23:431-443.

7. 7. Loadsman JA, Hillman DR. Anaesthesia and sleep apnoea. Br J Anesth 2001;86:254-266.

8. 8. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705-706.

9. 9. Sterier T, Punjabi NM. Demographics and diagnosis of obstructive sleep apnea. Anesthesiol Clin North Am 2005;23:405-420.

10. Young T, Evans L, Finn L, Palta M. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20:705-706.

11. Covarrubias GA, Martínez GJL, Reynada TJL. Actualidades en la vía aérea difícil. Rev Mex Anest 2004;27:210-218.

12. Hiremath AS, Hillman DR, James AL. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 1998;80:606-611.

13. Benumof JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. Anesthesiol Clin North Am 2002;20:789-811.

14. Ostermeier AM, Roizen MF, Hautkappe M, Klock PA, Klafta JM. Three sudden postoperative respiratory arrests associated with epidural opioids in patients with sleep apnea. Anesth Analg 1997;85:452-460.

15. Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc 2001;76:897-905.

16. Roche F, Xuong AN, Court-Fortune I, Costes F, Pichot V, Duverney D, Vergnon JM, Gaspoz JM, Barthelemy JC. Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing Clin Electrophysiol 2003;26:669-677.

17. Yun AJ, Lee PY, Bazar KA. Autonomic dysregu-lation as a basis of cardiovascular, endocrine, and inflammatory disturbances associated with obs-tructive sleep apnea and other conditions of chronic hypoxia, hypercapnia, and acidosis. Med Hypotheses 2004;62:852-866.

18. Redline S, Kump K, Tishler PV, Browner I, Ferrette V. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med 1994;149:722-726.

19. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJ, Walsleben JA, Finn L, Enright P, Samet JM; Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community dwelling adults: the Sleep Heart Health Study. Arch Intern Med 2002;162:893-900.

20. Liu PY, Yee B, Wishart SM, Jimenez M, Jung DG, Grunstein RR, Handelsman DJ. The short-term effects of high-dose testosterone on sleep, breathing, and function in older men. J Clin Endocrinol Metab 2003;88:3605-3613.

21. Stewart DA, Grunstein RR, Berthon-Jones M, Handelsman DJ, Sullivan CE. Androgen blockade does not affect sleep-disordered breathing or chemosensitivity in men with obstructive sleep apnea. Am Rev Respir Dis 1992;146:1389-1393.

22. Rosenow F, McCarthy V, Caruso AC. Sleep apnoea in endocrine diseases. J Sleep Res 1998;7:3-11.

23. Vgontzas AN, Chrousos GP. Sleep, the hypothalamic-pituitary-adrenal axis, and cytokines: multiple interactions and disturbances in sleep disorders. Endocrinol Metab Clin North Am 2002;31:15-36.

24. Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med 1994;154:1705-1711.

25. Vgontzas AN, Bixler EO, Tan TL, Kantner D, Martin LF, Kales A. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med 1998;22:158:1333-1337.

26. Burger CD, Stanson AW, Daniels BK, Sheedy PF 2nd, Shepard JW Jr. Fast-computed tomographic evaluation of the effect of route of breathing on upper airway size and function in normal men. Chest 1993;103:1032-1037.

27. Martin SE, Mathur R, Marshall I, Douglas NJ. The effect of age, sex, obesity and posture on upper airway size. Eur Respir J 1997;10:2087-2090.

28. Kronenberg RS, Drage CW. Attenuation of the ventilatory and heart rate responses to hypoxia and hypercapnia with aging in normal men. J Clin Invest 1973;52:1812-1879.

29. Worsnop C, Kay A, Kim Y. Effect of age on sleep onset-related changes in respiratory pump and upper airway muscle function. J Appl Physiol 2000;88: 1831-1839.

30. Hudgel DW, Devadatta P, Hamilton H. Pattern of breathing and upper airway mechanics during wakefulness and sleep in healthy elderly humans. J Appl Physiol 1993;74:2198-2204.

31. Passannante AN, Rock P. Anesthetic management of patients with obesity and sleep apnea. Anesthesiol Clin North Am 2005;23:479-491.

32. Dhonneur G, Combes X, Leroux B. Postoperative obstructive apnea. Anesth Analg 1999;89:762-767.

33. Strauss SG, Lynn AM, Bratton SL. Ventilatory response to CO2 in children with obstructive sleep apnea from adenotonsillar hypertrophy. Anesth Analg 1999;89:328-332.

34. Waters KA, McBrien F, Stewart P. Effects of OSA, inhalational anesthesia, and fentanyl on the airway and ventilation of children. J Appl Physiol 2002; 92:1987-1994.

35. Riley RW, Powell NB, Guilleminault C, Pelayo R, Troell RJ, Li KK. Obstructive sleep apnea surgery: risk management and complications. Otolaryngol Head Neck Surg 1997;117:648-652.

36. Bryson GL, Chung F, Finegan BA, Friedman Z, Miller RD, Van Vlymen J, Cox RG, Crowe MJ, Fuller J, Henderson C, for the Canadian Ambulatory Anesthesia Research and Education (CAARE) Group. Patient selection in ambulatory anesthesia — An evidence-based review: part I. Can J Anesth 2004;51:768-781.

37. Cullen DJ. Obstructive sleep apnea and post-operative analgesia: a potentially dangerous combination. J Clin Anesth 2001;13:83-85.

38. Rennotte MT, Baele P, Aubert G, Rodenstein DO. Nasal continuous positive airway pressure in the perioperative management of patients with obstructive sleep apnea submitted to surgery. Chest 1995;107: 367-374.