Volumen 64,Numero 1, Suplemento SAHOS, Revista de la Facultad de Medicina

Publicado

2017-08-02

Tratamiento quirúrgico por otorrinolaringología en el síndrome de apnea-hipopnea obstructiva del sueño (SAHOS)

Surgical treatment by otorhinolaryngology in obstructive sleep apnea-hypopnea syndrome (OSAHS)

Palabras clave:

Síndromes de la apnea del sueño, Procedimientos quirúrgicos operativos, Cirugía maxilofacial. (es)
Sleep Apnea Syndromes, Surgical Procedures, Operative, Surgery, Oral. (en)

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Autores/as

  • Andrés Vallejo-Balen Clínica del Country - Bogotá D.C. - Colombia.
  • Sandra Irene Zabala-Parra Cayre - Clínica especializada en trastornos del sueño - Bogotá D.C. - Colombia. Centro Médico Dalí - Bogotá D.C. - Colombia.
  • Steve Amado Hospital Central de la Policía - Servicio de Otorrinolaringología - Bogotá D.C. - Colombia.

El síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) se caracteriza por la obstrucción parcial o el colapso total de la vía aérea superior, de manera intermitente y repetitiva, por lo que, en un principio, se vio el manejo quirúrgico como una alternativa curativa para esta patología. Sin embargo, en la actualidad se reconoce que la cirugía, aun sin lograr tasas de efectividad muy altas de manera consistente, sí mejora la tolerancia y adaptación a la terapia de presión positiva, la cual sigue siendo la primera línea de manejo.

Así, el primer paso antes de pensar en cualquier procedimiento quirúrgico es un adecuado diagnóstico topográfico, de modo que siempre se debe realizar una nasofibrolaringoscopia para identificar el o los sitios de obstrucción. Además, se sabe que el 75% de los pacientes presentan obstrucciones en múltiples niveles y que, cuando el abordaje se hace multinivel, se logra corregir el SAHOS hasta en un 95%. Entre los procedimientos vigentes se encuentran cirugías de nariz, paladar blando, amígdalas, base de lengua, estimulación del nervio hipogloso y procedimientos del esqueleto facial, así como procedimientos coadyuvantes, entre los que están radiofrecuencia e implantes de paladar.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by the partial obstruction or total collapse of the upper airway in an intermittent and repetitive manner; in this scenario, surgical management was initially regarded as an alternative for treating this pathology. Nowadays, surgery is highly recognized because it improves tolerance and adaptation to positive pressure therapy; it remains as the first line of treatment, although high rates of effectiveness are not achieved.

The first step before considering any surgical procedure is an adequate topographic diagnosis; therefore, a nasofibrolaryngoscopy should always be performed to identify the obstruction site(s). It is known that 75% of patients have obstructions at multiple levels, so correcting OSAHS by up to 95% is possible when the approach considers all the levels. Current procedures include nasal surgery, soft palate, tonsils, tongue base, hypoglossal nerve stimulator and facial skeletal procedures, as well as adjuvant procedures that include radiofrequency and palate implants.

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Citas

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