Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica
Ano de defesa: | 2022 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Dissertação |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Pontif?cia Universidade Cat?lica do Rio Grande do Sul
|
Programa de Pós-Graduação: |
Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de
|
Departamento: |
Escola de Medicina
|
País: |
Brasil
|
Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | https://tede2.pucrs.br/tede2/handle/tede/10299 |
Resumo: | Carvalho TR. Assessment of screening for obstructive sleep apnea with polysomnography in patients undergoing bariatric surgery. 79f. Dissertation (Master?s) ? School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, 2022. Introduction: Obesity is increasing its incidence worldwide. Bariatric surgery is a therapeutic modality for obesity treatment that has excellent outcomes. To try to minimize the risks of bariatric surgery, a proper preoperative should be performed. There is a high prevalence of Obstructive Sleep Apnea Syndrome (OSA) associated with people with obesity, and different studies have found a relationship between the presence of OSA with postoperative pulmonary and cardiovascular events (<30 days) in different types of surgery. For this reason, different guidelines recommend screening for OSA in people undergoing bariatric surgery. However, polysomnography is an exam not widely available. Also, in the context of bariatric surgery, some studies diverged on the benefits of this screening. Objective: To assess the impact of OSA screening, using polysomnography, on cardiovascular and pulmonary complications in the postoperative period of bariatric surgery. Methods: This was a single-center retrospective cohort study, including 522 adults who underwent bariatric surgery between August 2010 and May 2019. Electronic medical records were accessed to obtain variables of interest. Screening for OSA was recorded as positive if the Apnea-Hypopnea Index was ?5 events/hour in patients with no previous diagnosis of OSA. The primary outcome was the presence of cardiovascular and pulmonary complications in the 30-day postoperative period. Secondary outcomes include length of stay (days), need for an intensive care unit (ICU) after surgery, time to mechanical adaptation, and time to withdrawal from intensive care. Statistical analyzes were performed with ?2, Fisher's exact test, Student's t test, Mann-Whitney U test and Poisson regression. Results: We included 522 participants in this study, 326 underwent screening for OSA with polysomnography, and 196 did not undergo this screening. Baseline characteristics were similar between groups, except for the profile of some evaluated comorbidities (smoking, asthma, hypertension, heart failure), which were included in the logistic regression for correct analysis. There was no difference in cardiopulmonary events between the screening and non-screening groups (4.2% vs. 2.8%; P = 0.45). Polysomnographic screening did not reduce postoperative cardiovascular or pulmonary complications, RR = 1.73 (95% CI: 0.68?4.14). There was no difference between the groups regarding ICU admission, length of stay, and duration of mechanical ventilation. However, patients undergoing screening had a longer waiting time until the surgical procedure (average waiting time of 1,269 days in the screening group versus 827 days in the non-screening group). Conclusion: OSA screening did not change postoperative cardiovascular and pulmonary events in postoperative period. Also, screening is associated with longer waiting time for surgery. Therefore, OSA screening with polysomnography can be suppressed in the preoperative period of bariatric surgery. Indications for polysomnography should be made at the individual level and current preoperative guidelines should be reviewed. |
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Fay, Gabriela Heiden Tel?http://lattes.cnpq.br/4883317062917508http://lattes.cnpq.br/3553794912250735Carvalho, Ta?se Rosa de2022-06-13T12:27:50Z2022-03-07https://tede2.pucrs.br/tede2/handle/tede/10299Carvalho TR. Assessment of screening for obstructive sleep apnea with polysomnography in patients undergoing bariatric surgery. 79f. Dissertation (Master?s) ? School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, 2022. Introduction: Obesity is increasing its incidence worldwide. Bariatric surgery is a therapeutic modality for obesity treatment that has excellent outcomes. To try to minimize the risks of bariatric surgery, a proper preoperative should be performed. There is a high prevalence of Obstructive Sleep Apnea Syndrome (OSA) associated with people with obesity, and different studies have found a relationship between the presence of OSA with postoperative pulmonary and cardiovascular events (<30 days) in different types of surgery. For this reason, different guidelines recommend screening for OSA in people undergoing bariatric surgery. However, polysomnography is an exam not widely available. Also, in the context of bariatric surgery, some studies diverged on the benefits of this screening. Objective: To assess the impact of OSA screening, using polysomnography, on cardiovascular and pulmonary complications in the postoperative period of bariatric surgery. Methods: This was a single-center retrospective cohort study, including 522 adults who underwent bariatric surgery between August 2010 and May 2019. Electronic medical records were accessed to obtain variables of interest. Screening for OSA was recorded as positive if the Apnea-Hypopnea Index was ?5 events/hour in patients with no previous diagnosis of OSA. The primary outcome was the presence of cardiovascular and pulmonary complications in the 30-day postoperative period. Secondary outcomes include length of stay (days), need for an intensive care unit (ICU) after surgery, time to mechanical adaptation, and time to withdrawal from intensive care. Statistical analyzes were performed with ?2, Fisher's exact test, Student's t test, Mann-Whitney U test and Poisson regression. Results: We included 522 participants in this study, 326 underwent screening for OSA with polysomnography, and 196 did not undergo this screening. Baseline characteristics were similar between groups, except for the profile of some evaluated comorbidities (smoking, asthma, hypertension, heart failure), which were included in the logistic regression for correct analysis. There was no difference in cardiopulmonary events between the screening and non-screening groups (4.2% vs. 2.8%; P = 0.45). Polysomnographic screening did not reduce postoperative cardiovascular or pulmonary complications, RR = 1.73 (95% CI: 0.68?4.14). There was no difference between the groups regarding ICU admission, length of stay, and duration of mechanical ventilation. However, patients undergoing screening had a longer waiting time until the surgical procedure (average waiting time of 1,269 days in the screening group versus 827 days in the non-screening group). Conclusion: OSA screening did not change postoperative cardiovascular and pulmonary events in postoperative period. Also, screening is associated with longer waiting time for surgery. Therefore, OSA screening with polysomnography can be suppressed in the preoperative period of bariatric surgery. Indications for polysomnography should be made at the individual level and current preoperative guidelines should be reviewed.Carvalho TR. Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de S?ndrome da Apneia Obstrutiva do Sono em pacientes submetidos ? cirurgia bari?trica. 79f. Disserta??o (Mestrado) ? Escola de Medicina, Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Porto Alegre, 2022. Introdu??o: A incid?ncia de obesidade vem crescendo globalmente e, com esse crescimento, torna-se cada vez mais necess?ria a institui??o de medidas terap?uticas com vistas a reduzir morbidades associadas. A cirurgia bari?trica apresenta excelentes resultados tanto na perda ponderal, quanto na manuten??o da perda de peso. Por?m, por se tratar de um procedimento cir?rgico, apresenta riscos inerentes ? modalidade de tratamento. Para tentar minimizar os riscos da cirurgia bari?trica, um pr?-operat?rio adequado deve ser realizado. Existe uma elevada preval?ncia de S?ndrome de Apneia Obstrutiva do Sono (SAOS) em indiv?duos com obesidade, e diferentes estudos encontraram rela??o entre a presen?a de SAOS com piores desfechos pulmonares e cardiovasculares no p?s-operat?rio (<30 dias) em diferentes tipos cir?rgicos. Por este motivo, diferentes diretrizes recomendam o rastreio de SAOS em indiv?duos que ser?o submetidos ? cirurgia bari?trica. Entretanto, a polissonografia ? um exame pouco dispon?vel populacionalmente e, no contexto de cirurgia bari?trica especificamente, alguns estudos divergiram sobre os benef?cios deste rastreio. Objetivo: Avaliar o impacto do rastreamento de SAOS com o uso de polissonografia em complica??es cardiovasculares e pulmonares no p?s-operat?rio de cirurgia bari?trica. M?todos: Este foi um estudo de coorte retrospectivo unic?ntrico, incluindo 522 adultos submetidos ? cirurgia bari?trica entre agosto de 2010 e maio de 2019. Os prontu?rios eletr?nicos foram acessados para obter as vari?veis de interesse. A triagem para SAOS foi registrada como positiva quando o ?ndice de Apneia-Hipopneia foi ?5 eventos/horas em pacientes que n?o tinham diagn?stico pr?vio de SAOS. O desfecho prim?rio foi a presen?a de complica??es cardiovasculares e pulmonares no p?s-operat?rio de 30 dias. Os desfechos secund?rios inclu?ram tempo de interna??o (dias), necessidade de uma unidade de terapia intensiva (UTI) ap?s a cirurgia, tempo de ventila??o mec?nica e tempo de retirada da ventila??o mec?nica. As an?lises estat?sticas foram realizadas com ??, teste exato de Fisher, teste t de Student, teste U de Mann-Whitney e regress?o de Poisson. Resultados: 522 indiv?duos foram inclu?dos neste estudo, 326 realizaram rastreio de SAOS com polissonografia e 196 n?o realizaram este rastreio. As caracter?sticas do baseline foram semelhantes entre os grupos, exceto pelo perfil de algumas comorbidades avaliadas (tabagismo, asma, hipertens?o, insufici?ncia card?aca), que foram posteriormente inclu?das em regress?o log?stica para an?lise. N?o houve diferen?a nos eventos cardiopulmonares entre os grupos de rastreio e n?o rastreio (4,2% vs. 2,8%; P = 0,45). A triagem com polissonografia n?o reduziu as complica??es cardiovasculares ou pulmonares no p?s-operat?rio, RR = 1,73 (IC 95%: 0,68?4,14). N?o houve diferen?a, entre os grupos, em rela??o a admiss?o ? UTI, tempo de interna??o e tempo de ventila??o mec?nica. Entretanto, paradoxalmente, pacientes que fizeram rastreio apresentaram tempo de espera maior at? o procedimento cir?rgico (tempo m?dio de espera de 1269 dias no grupo rastreio vs. 827 dias no grupo sem rastreio). Conclus?o: Sugere-se que o rastreamento da SAOS com polissonografia no pr?-operat?rio de cirurgia bari?trica ? um procedimento dispens?vel, pois n?o altera os desfechos cardiopulmonares p?s- operat?rios, podendo aumentar, ainda mais, o tempo de espera pr?-operat?ria desses pacientes. As indica??es para polissonografia devem ser feitas em n?vel individual e as diretrizes de pr?-operat?rio vigentes devem ser revisadas.Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2022-06-10T20:24:16Z No. of bitstreams: 1 TA?SE ROSA DE CARVALHO Disserta??o Mestrado Final (2) (3).pdf: 4444103 bytes, checksum: cf388a275d84b80b1bc8df7843716515 (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2022-06-13T11:55:04Z (GMT) No. of bitstreams: 1 TA?SE ROSA DE CARVALHO Disserta??o Mestrado Final (2) (3).pdf: 4444103 bytes, checksum: cf388a275d84b80b1bc8df7843716515 (MD5)Made available in DSpace on 2022-06-13T12:27:50Z (GMT). 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dc.title.por.fl_str_mv |
Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica |
title |
Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica |
spellingShingle |
Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica Carvalho, Ta?se Rosa de Obesidade Dissonias Dist?rbios do In?cio e da Manuten??o do Sono Cuidados Pr?-Operat?rios Cirurgia Bari?trica Obesity Dyssomnia Sleep Initiation and Maintenance Disorders Preoperative Care CIENCIAS DA SAUDE::MEDICINA |
title_short |
Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica |
title_full |
Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica |
title_fullStr |
Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica |
title_full_unstemmed |
Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica |
title_sort |
Avalia??o do impacto da realiza??o de polissonografia no rastreio pr?-operat?rio de s?ndrome da apneia obstrutiva do sono em pacientes submentidos ? cirurgia bari?trica |
author |
Carvalho, Ta?se Rosa de |
author_facet |
Carvalho, Ta?se Rosa de |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Fay, Gabriela Heiden Tel? |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/4883317062917508 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/3553794912250735 |
dc.contributor.author.fl_str_mv |
Carvalho, Ta?se Rosa de |
contributor_str_mv |
Fay, Gabriela Heiden Tel? |
dc.subject.por.fl_str_mv |
Obesidade Dissonias Dist?rbios do In?cio e da Manuten??o do Sono Cuidados Pr?-Operat?rios Cirurgia Bari?trica |
topic |
Obesidade Dissonias Dist?rbios do In?cio e da Manuten??o do Sono Cuidados Pr?-Operat?rios Cirurgia Bari?trica Obesity Dyssomnia Sleep Initiation and Maintenance Disorders Preoperative Care CIENCIAS DA SAUDE::MEDICINA |
dc.subject.eng.fl_str_mv |
Obesity Dyssomnia Sleep Initiation and Maintenance Disorders Preoperative Care |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA |
description |
Carvalho TR. Assessment of screening for obstructive sleep apnea with polysomnography in patients undergoing bariatric surgery. 79f. Dissertation (Master?s) ? School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, 2022. Introduction: Obesity is increasing its incidence worldwide. Bariatric surgery is a therapeutic modality for obesity treatment that has excellent outcomes. To try to minimize the risks of bariatric surgery, a proper preoperative should be performed. There is a high prevalence of Obstructive Sleep Apnea Syndrome (OSA) associated with people with obesity, and different studies have found a relationship between the presence of OSA with postoperative pulmonary and cardiovascular events (<30 days) in different types of surgery. For this reason, different guidelines recommend screening for OSA in people undergoing bariatric surgery. However, polysomnography is an exam not widely available. Also, in the context of bariatric surgery, some studies diverged on the benefits of this screening. Objective: To assess the impact of OSA screening, using polysomnography, on cardiovascular and pulmonary complications in the postoperative period of bariatric surgery. Methods: This was a single-center retrospective cohort study, including 522 adults who underwent bariatric surgery between August 2010 and May 2019. Electronic medical records were accessed to obtain variables of interest. Screening for OSA was recorded as positive if the Apnea-Hypopnea Index was ?5 events/hour in patients with no previous diagnosis of OSA. The primary outcome was the presence of cardiovascular and pulmonary complications in the 30-day postoperative period. Secondary outcomes include length of stay (days), need for an intensive care unit (ICU) after surgery, time to mechanical adaptation, and time to withdrawal from intensive care. Statistical analyzes were performed with ?2, Fisher's exact test, Student's t test, Mann-Whitney U test and Poisson regression. Results: We included 522 participants in this study, 326 underwent screening for OSA with polysomnography, and 196 did not undergo this screening. Baseline characteristics were similar between groups, except for the profile of some evaluated comorbidities (smoking, asthma, hypertension, heart failure), which were included in the logistic regression for correct analysis. There was no difference in cardiopulmonary events between the screening and non-screening groups (4.2% vs. 2.8%; P = 0.45). Polysomnographic screening did not reduce postoperative cardiovascular or pulmonary complications, RR = 1.73 (95% CI: 0.68?4.14). There was no difference between the groups regarding ICU admission, length of stay, and duration of mechanical ventilation. However, patients undergoing screening had a longer waiting time until the surgical procedure (average waiting time of 1,269 days in the screening group versus 827 days in the non-screening group). Conclusion: OSA screening did not change postoperative cardiovascular and pulmonary events in postoperative period. Also, screening is associated with longer waiting time for surgery. Therefore, OSA screening with polysomnography can be suppressed in the preoperative period of bariatric surgery. Indications for polysomnography should be made at the individual level and current preoperative guidelines should be reviewed. |
publishDate |
2022 |
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2022-06-13T12:27:50Z |
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2022-03-07 |
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Pontif?cia Universidade Cat?lica do Rio Grande do Sul |
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Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de |
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PUCRS |
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Brasil |
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Pontif?cia Universidade Cat?lica do Rio Grande do Sul |
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Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) |
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biblioteca.central@pucrs.br|| |
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