Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942006000600012
Brazilian Journal of Anesthesiology
Review Article

Anestesia e apnéia obstrutiva do sono

Anesthesia and obstructive sleep apnea

Charles Machado; Américo Massafuni Yamashita; Sonia Maria Guimarães Pereira Togeiro; Dalva Poyares; Sérgio Tufik

http://dx.doi.org/10.1590/S0034-70942006000600012 Braz J Anesthesiol, vol.56, n6, p.669-678, 2006
PDF Português
PDF English
Downloads: 1
Views: 1107

Resumo

JUSTIFICATIVA E OBJETIVOS: A manutenção da permeabilidade das vias aéreas superiores (VAS) é fundamental para anestesia e para pacientes com apnéia obstrutiva do sono (AOS). Durante ambos os estados ocorre uma redução do tônus da musculatura faríngea. Identificar pacientes com AOS é importante a fim de prevenir riscos durante o período perioperatório. O objetivo deste trabalho foi apresentar uma revisão sobre a relação entre AOS e anestesia, levando em conta o planejamento da anestesia, enfatizando a importância da identificação da síndrome da apnéia e hipopnéia obstrutiva do sono (SAHOS). CONTEÚDO: A SAHOS ocorre principalmente por colapso total ou parcial da faringe, podendo levar a diminuição na saturação da oxiemoglobina e complicações cardiovasculares. Os principais fatores predisponentes são sexo masculino, obesidade, características crânio e orofaciais. Seu diagnóstico é clínico e polissonográfico, o que também quantifica a gravidade da AOS. Os pacientes com SAHOS especialmente acentuada podem apresentar problemas durante a intubação traqueal e sedação, estando alguns mais susceptíveis à ocorrência de hipóxia e hipercapnia, mesmo na vigência de pulmões normais. Os autores discutem a importância do diagnóstico prévio e tratamento da SAHOS na tentativa de reduzir o risco anestésico. CONCLUSÕES: O diagnóstico e tratamento prévio da SAHOS com pressão positiva contínua nas VAS podem reduzir complicações perioperatórias e influenciar na conduta anestésica e na recuperação pós-anestésica.

Palavras-chave

DOENÇAS, Apnéia Obstrutiva do Sono, VENTILAÇÃO, pressão positiva contínua

Abstract

BACKGROUND AND METHODS: Maintaining the patency of the upper airways is fundamental to anesthesia and patients with obstructive sleep apnea (OSA). During anesthesia and while a person is sleeping, the tonus of the pharyngeal muscles is reduced. It is important to identify patients with OSA to prevent risks in the perioperative period. The objective of this report was to present a revision of the relationship between OSA and anesthesia regarding planning of anesthesia, stressing the importance of identifying the obstructive sleep apnea hypopnea syndrome (OSAHS). CONTENTS: OSAHS is caused mainly by total or partial pharyngeal collapse, which may cause a reduction in hemoglobin saturation and cardiovascular complications. The main predisposing factors include male gender, obesity, and cranial and orofacial characteristics. It is diagnosis by its clinical and polysomnographic characteristics, which also determine its severity. Patients with severe OSAHS may present problems during tracheal intubation and sedation, and may be more susceptible to hypoxia and hypercapnia, even in the presence of normal lungs. The authors discuss the importance of diagnosing and treating OSAHS before surgeries in order to reduce the anesthetic risk. CONCLUSION: Prior diagnosis and treatment of OSAHS with continuous positive pressure in the upper airways may reduce perioperative complications and influence the anesthetic and postanesthetic management.

Keywords

DISEASES, Obstructive Sleep Apnea, VENTILATION, continuous positive airway pressure

References

Hillman DR, Loadsman JA, Platt PR. Obstructive sleep apnea and anesthesia. Sleep Med Rev. 2004;8:459-471.

Sleep-Related Breathing Disorders in Adults: Recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force. 1999;22:667-689.

Young T, Palta M, Dempsey J. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-1235.

Shamsuzzaman AS, Gersh BJ, Somers VK. Obstructive sleep apnea - Implications for cardiac and vascular disease. JAMA. 2003;290:1906-1914.

Morgan BJ, Crabtree DC, Puleo DS. Neurocirculatory consequences of abrupt change in sleep state in humans. J Appl Physiol. 1996;80:1627-1636.

Narkiewicz K, Somers VK. Sympathetic nerve activity in obstructive sleep apnea. Acta Physiol Scand. 2003;177:385-390.

Krieger J, Laks L, Wilcox I. Atrial natriuretic peptide release during sleep in patients with obstructive sleep apnea before and during treatment with continuous positive airway pressure. Clin Sci. 1989;77:407-411.

Masa JF, Rubio M, Findley L. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Resp Crit Care Med. 2000;162:1407-1412.

Nieto FJ, Young TB, Lind BK. Association of sleep disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA. 2000;283:1829-1836.

Loadsman JA, Hillman DR. Anaesthesia and sleep apnea. Br J Anaesth. 2001;86:254-266.

Eastwood PR, Szollosi I, Platt PR. Collapsibility of the upper airway during anesthesia with isoflurane. Anesthesiology. 2002;97:786-793.

Gold AR, Schwartz AR. The pharyngeal critical pressure. Chest. 1996;110:1077-1088.

Smith PL, Wise RA, Gold AR. Upper airway pressureflow relationships in obstructive sleep apnea. J Appl Physiol. 1988;64:789-795.

Strobel RJ, Rosen RC. Obesity and weight loss in obstructive sleep apnea: a critical review. Sleep. 1996;19:104-115.

Redline S, Strohl KP. Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med. 1998;19:1-20.

Ancoli-Israel S, Kripke DF, Klauber MR. Sleep-disordered breathing in community-dwelling elderly. Sleep. 1991;14:1054-1058.

Kales A, Cadieux RJ, Bixler EO. Severe obstructive sleep apnea: onset, clinical course and characteristics. . 1985;38:419-425.

Masa JF, Rubio M, Findley L. Habitually sleepy drivers have a high frequency of automobile crashes associate with respiratory disorders during sleep. Am J Respir Crit Care Med. 2000;162:1407-1412.

Cherniack NS. New mechanisms for the cardiovacular effects of sleep apnea. Am J Med. 2000;109:592-594.

Lavie P, Herer P, Hoffstein V. Obstructive sleep apnea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320:479-482.

Peppard PE, Young T, Palta M. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378-1384.

The sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. Arch Intern Med. 1997;157:2413-2446.

Pedrinelli R, Giampietro O, Carmassi F. Microalbuminuria and endothelial dysfunction in essential hypertension. Lancet. 1994;344:14-18.

Lee IK, Kim HS, Bae JH. Endothelial dysfunction: its relationship with acute hyperglycaemia and hyperlipidemia. Int J Clin Pract. 2002;129:59-64.

Ciarla MV, Bocciarelli A, Di Gregorio S. Autoantibodies and endothelial dysfunction in well-controlled, uncomplicated insulin-dependent diabetes mellitus patients. Atherosclerosis. 2001;158:241-246.

Wascher TC, Graier WF, Bahadori B. Time course of endothelial dysfunction in diabetes mellitus. Circulation. 1994;90:1109-1110.

Milionis HJ, Jeremy JY, Mikhailidis DP. Regarding "smoking is associated with dose-related increase of intima-media thickness and endothelial dysfunction. Angiology. 1999;50:959-961.

Poredos P, Orehek M, Tratnik E. Smoking is associated with dose-related increase of intima-media thickness and endothelial dysfunction. Angiology. 1999;50:201-208.

D'Alessandro R, Magelli C, Gamberini G. Snoring every night as a risk factor for myocardial infarction: a case-control study. BMJ. 1990;300:1557-1558.

Hung J, Whitford EG, Parsons RW. Association of sleep apnea with myocardial infarction in men. Lancet. 1990;336:261-264.

Shahar E, Whitney CW, Redline S. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19-25.

EL-Solh AA, Mador MJ, Sikka P. Adhesion molecules in patients with coronary artery disease and moderate-to-severe obstructive sleep apnea. Chest. 2002;162:2166-2171.

IP MSM, Lam B, Chan LY. Circulation nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med. 2000;162:2166-2171.

Schultz A, Lavie L, Hochberg I. Interindividual heterogeneity in the hypoxic regulation of VEGF: significance for the development of the coronary artery collateral circulation. Circulation. 1999;100:547-552.

Schultz A, Hummel C, Heinemann S. Serum levels of vascular endothelial growth factor are elevated in patients with obstructive sleep apnea and severe nighttime hypoxia. Am J Respir Crit Care Med. 2002;165:67-70.

Lavai L, Kraiczi H, Hefetz A. Plasma vascular endothelial growth factor in sleep apnea syndrome. Am J Respir Crit Care Med. 2002;165:1624-1628.

Shahar E, Whitney CW, Redline S. Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. ;2001:163.

Sin DD, Fitzgerald F, Parker JD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med. 1999;160:1101-1106.

Redfield MM, Jacobsen SJ, Burnett JET. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003;289:194-2002.

Finkel MS, Oddis CV, Jacob TD. Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science. 1992;257:387-389.

Du Bois JS, Udelson JE, Atkins MB. Severe reversible global and regional ventricular dysfunction associated with high-dose interleukin-2 immunotherapy. J Immunother Emphasis Tumor Immunol. 1995;18:119-123.

Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217-1239.

Gupta RM, Parvizi J, Hanssen AD. 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.

Burgess LP, Derderian SS, Morin GV. Postoperative risk following uvulopalatopharyngoplasty for obstructive sleep apnea. Otolaryngol Head Neck Surg. 1992;106:81-86.

McColley SA, April MM, Carroll JL. Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 1992;118:940-943.

Kravath RE, Pollak CP, Borowiecki B. Obstructive sleep apnea and death associated with surgical correction of velopharyngeal incompetence. J Pediatr. 1980;96:645-648.

Valnicek SM, Zuker RM, Halpern LM. Perioperative complications of superior pharyngeal flap surgery in children. Plast Reconstr Surg. 1994;93:954-958.

Meoli AL, Rosen CL, Kristo D. Upper airway management of the adult patient with obstructive sleep apnea in the perioperative period-avoiding complications. Sleep. 2003;26:1060-1065.

Viner S, Szalai JP, Hoffstein V. Are history and examination a good screening test for sleep apnea. Ann Intern Med. 1991;115:356-359.

Benumof JL. Obstructive Sleep Apnea in adult obese patients: implications for airway management. Anesthesiology Clin N Am. 2002;20:789-811.

Metha Y, Manikappa S, Juneja R. Obstructive sleep apnea syndrome: anesthetic implications in the cardiac surgical patient. J Cardiothorac Vasc Anesth. 2000;14:449-453.

Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry and deep breathing in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis. 1984.

5dd2fe7e0e8825e706c63494 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections