Síndrome da Apneia Obstrutiva do Sono Fisiopatologia, Epidemiologia, Consequências, Diagnóstico e Tratamento

 

Adão Pereira

Faculdade de Medicina Dentária da Universidade do Porto

 

 

A síndrome da apneia obstrutiva do sono (SAOS) é uma condição caracterizada por obstruções repetidas das vias aéreas superiores que resultam, frequentemente, em dessaturação de oxigénio e despertares do sono. A hipersonolência diurna é uma manifestação clássica da SAOS mas outros sintomas tais como sono não reparador, capacidade de concentração diminuída e fadiga são frequentemente referidos. Outras consequências da respiração anormal durante o sono incluem disfunção neurocognitiva, desenvolvimento de doenças cardiovasculares, disfunção metabólica e redução da qualidade de vida. A SAOS é mais comum nos homens obesos com mais de 40 anos e nas mulheres obesas após a menopausa. Os factores de risco para a SAOS incluem a obesidade, hipertrofia das amígdalas e/ou das adenóides e anomalias craniofaciais como, por exemplo, a retrognatia e a micrognatia. A maioria dos doentes com SAOS são obesos e a obesidade é conhecida como um factor de risco crucial. As opções terapêuticas incluem a perda de peso quando a doença está relacionada com a obesidade e outras medidas gerais (abstenção de bebidas alcoólicas e de fármacos com efeitos sedativos, e cessação dos hábitos tabágicos). A aplicação por via nasal de uma pressão positiva de ar (CPAP) é o meio mais eficaz no tratamento de todos os sintomas da SAOS, qualquer que seja o seu grau de gravidade. O tratamento cirúrgico deve ser entendido como um último recurso e em casos seleccionados.

Palavras-chave: apneia obstrutiva do sono; fisiopatologia; epidemiologia; consequências; diagnóstico; tratamento.

 

 

Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is a condition characterized by repetitive obstruction of the upper airway often resulting in oxygen desaturation and arousals from sleep. The classic manifestation is excessive sleepiness but other symptoms such as unfreshing sleep, poor concentration and fatigue are commonly reported. Other consequences of the abnormal breathing during sleep include neurocognitive dysfunction, development of cardiovascular disorders, metabolic dysfunction, and impaired quality of life. OSAS is a sleep breathing disorder that is most common in obese men over the age of 40 and obese women after menopause. The common risk factors for OSAS include obesity, enlarged tonsils and adenoids, and craniofacial abnormalities (e.g., retrognathia and micrognathia). The vast majority of OSAS cases are obese and obesity is known as a crucial risk factor. Therapeutical options include weight loss by either caloric restriction or bariatric surgery when the disease is related to obesity and other general measures (alcohol and sedatives such as benzodiazepines avoidance and smoking cessation). The application of nasal CPAP remains highly effective for the treatment of all symptoms related to all degrees of OSAS. The surgery only must be considered in selected cases.

Key-words: obstructive sleep apnea; physiopathology; epidemiology; consequences; diagnosis; treatment.

 

 

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Correspondência:

Prof. Adão Pereira

Faculdade de Medicina Dentária Universidade do Porto

Rua Dr. Manuel Pereira da Silva

4200-392 Porto

e-mail: mllobop@portugalmail.pt