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Editorial
Obstructive Sleep Apnea and Surgery: Wake up for the problem!
Apneia Obstrutiva do Sono e Cirurgia: prestem atenção
Geraldo Lorenzi-Filhoa,
Corresponding author
geraldo.lorenzi@gmail.com

Corresponding author.
, Pedro Rodrigues Gentaa, Luciano Dragerb
a Pulmonary Division, Sleep Laboratory of the Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
b Cardiology Division, Sleep Laboratory of the Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Obstructive sleep apnea &#40;OSA&#41; is a common disease characterized by repetitive obstruction of the upper airways during sleep&#46; It is now recognized that OSA is much more prevalent than previously thought&#46; For instance&#44; one recent study of a representative sample of the city of S&#227;o Paulo&#44; Brazil&#44; found that 33&#37; of the adult population presented OSA syndrome as defined by full polysomnography showing an apnea-hypopnea index above 5 events&#47;hour plus symptoms or an apnea-hypopnea index &#62;<span class="elsevierStyleHsp" style=""></span>15 events per hour independent of symptoms<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; The prevalence of OSA may be even higher among specific populations for at least 2 reasons&#46; Firstly&#44; because OSA shares several risk factors with common conditions such as obesity&#44; hypertension and diabetes and secondly&#44; OSA once present triggers a series of pathways that may negatively affect co-morbid conditions such as high blood pressure and insulin resistance<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Independently of the exact mechanism&#44; it is well Known that among patients with established diagnosis of hypertension<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#44; resistant hypertension<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and metabolic syndrome<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> the prevalence of OSA is strikingly high and varies from 30 to 70&#37;&#46; The recognition of OSA among surgical patients is particularly important&#46; Despite the fact that awareness is still low&#44; one should anticipate a high prevalence of OSA solely based solely on the presence of the demographic and clinical conditions commonly observed in this population&#46; In addition&#44; although not fully established&#44; it is clear that there may be an association between unrecognized OSA and the increased risk of post operative complications&#46; Finally&#44; the pre-operative setting is a good time to investigate co-morbidities because patients may be more receptive to lifestyle and medical interventions&#46; On the other hand&#44; a major limitation in the recognition of OSA is the limited access to the full polysomnography that is considered the gold standard method for OSA diagnosis&#46; In this context&#44; screening questionnaires are important in facilitating identification of OSA patients and in keeping down costs&#46; In this issue of the Portuguese Journal of Pulmonology&#44; Pereira and colleagues evaluated the prevalence of OSA symptoms using a validated questionnaire &#40;STOP-BANG score&#41; in 357 surgical patients admitted to the Post-Anesthesia Care Unit<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; The STOP-BANG questionnaire has been designed to detect OSA in the surgical population and presents a high sensitivity to detecting OSA&#44; but has a low specificity&#46; The positive questionnaire may result in a high number of false-positives&#46; Therefore&#44; if the primary goal is to include all cases of OSA&#44; the STOP-BANG questionnaire is a good option&#44; but ideally the final diagnosis would require a diagnostic test&#46; One interesting option for OSA diagnosis in the surgical population is the use of portable monitoring which has been previously validated among patients waiting for coronary artery bypass surgery<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;The prevalence of patients with traits that are suggestive of OSA as evaluated by the STOP-BANG questionnaire in the study of Pereira and colleagues was very high &#40;slightly over 50&#37;&#41;&#46; The estimated prevalence of OSA is striking&#44; and clearly suggests that the vast majority of the patients in the surgical population remain undiagnosed&#46; More importantly&#44; the authors also showed that patients with suggestive of OSA were more likely to present post operative complications&#46; The question not answered in this study is whether OSA is in fact an independent risk factor for complications&#44; or whether co-variables such as obesity or other co-morbid conditions&#44; could fully explain the negative association&#46; In conclusion&#44; the paper by Pereira et al raises several important questions about the identification and consequences of OSA in the perioperative period&#46; Further research on the impact of recognition and treatment of OSA in the population of patients submitted to surgeries should be mandatory&#46;</p></span>"
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Article information
ISSN: 08732159
Original language: English
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