نبذة مختصرة : Obesity is one of the most important risk factors in sleep-related respiratory disorders; more than 70% of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) show some degree of obesity. Weight loss, through medical or surgical means, should be a primary goal in the management of OSAHS since it improves the apnea-hypopnea index (AHI) in a high percentage, which should be stimulated in all patients.Changes in the lifestyle are the first step and should be done through multi-component interventions that include eating habits, physical activity, and psychological support. If after three to six months of treatment the goals established for weight loss have not been met, drugs against obesity or bariatric surgery can be formulated. The current risk of undergoing bariatric surgery is low and the benefits are evident. ; La obesidad es uno de los factores de riesgo más importantes en los trastornos respiratorios relacionados con el sueño. Más de 70% de los pacientes con síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) presenta algún grado de obesidad. La pérdida de peso, ya sea médica o quirúrgica, debe ser un objetivo primordial en el manejo del SAHOS al mejorar el índice de apnea-hipopnea (IAH) en un alto porcentaje, el cual se debe estimular en todos los pacientes. Siempre se debe iniciar con cambios en el estilo de vida a través de intervenciones con múltiples componentes que incluyen hábitos alimentarios, actividad física y soporte psicológico. Si después de 3 a 6 meses de tratamiento no se han alcanzado las metas de peso establecidas, se pueden formular medicamentos contra la obesidad o cirugía bariátrica. El riesgo actual de someterse a una cirugía bariátrica es bajo y los beneficios son evidentes.
Relation: https://revistas.unal.edu.co/index.php/revfacmed/article/view/60090/61299; https://revistas.unal.edu.co/index.php/revfacmed/article/view/60090/61300; https://revistas.unal.edu.co/index.php/revfacmed/article/view/60090/63201; Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. The evidence report: National Institutes of Health. Bethesda: National Heart, Lung, and Blood Institute; 1998. Report: 98-4083.; Eknoyan G. Obesity and chronic kidney disease. Nefrologia. 2011;31(4):397-403. http://doi.org/f23nwm.; Wei YF, Wu HD. Candidates for bariatric surgery: morbidly obese patients with pulmonary dysfunction. J Obes. 2012;2012:1-6. http://doi.org/bntb.; Sharkey KM, Machan JT, Tosi C, Roye GD, Harrington D, Millman RP. Predicting obstructive sleep apnea among women candidates for bariatric surgery. J Womens Health (Larchmt). 2010;19(10):1833-41. http://doi.org/fd34vc.; Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-21. http://doi.org/cq6gz9.; Sharkey KM, Orff HJ, Tosi C, Harrington D, Roye GD, Millman RP. Subjective sleepiness and daytime functioning in bariatric patients with obstructive sleep apnea. Sleep Breath. 2013;17(1):267-74. http://doi.org/bntc.; Dixon JB, Schachter LM, O’Brien PE. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes (Lond). 2005;29(9):1048-54. http://doi.org/bht7wv.; Schwab RJ, Gupta KB, Gefter WB, Metzger LJ, Hoffman EA, Pack AI. Upper airway and soft tissue anatomy in normal subjects and patients with sleep-disordered breathing. Significance of the lateral pharyngeal walls. Am J Respir Crit Care Med. 1995;152(5 Pt 1):1673-89. http://doi.org/bntd.; Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology. 2012;17(1):32-42. http://doi.org/fd3s89.; Davis G, Patel JA, Gagne DJ. Pulmonary considerations in obesity and the bariatric surgical patient. Med Clin North Am. 2007;91(3):433-42. http://doi.org/bhkgtp.; Aguiar IC, Freitas WR Jr, Santos IR, Apostolico N, Nacif SR, Urbano JJ, et al. Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial. Multidiscip Respir Med. 2014;9(1):43. http://doi.org/bntf.; Tuomilehto H., Seppä J, Uusitupa M. Obesity and obstructive sleep apnea--clinical significance of weight loss. Sleep Med Rev. 2013;17(5):321-9. http://doi.org/bntg.; Sarkhosh K, Switzer NJ, El-Hadi M, Birch DW, Shi X, Karmali S. The impact of bariatric surgery on obstructive sleep apnea: a systematic review. Obes Surg. 2013;23(3):414-23. http://doi.org/bnth.; Ashrafian H, Toma T, Rowland SP, Harling L, Tan A, Efthimiou E, et al. Bariatric surgery or non-surgical weight loss for obstructive sleep apnea? A systematic review and comparison of meta-analyses. Obes Surg. 2015;25(7):1239-50. http://doi.org/bntj.; World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO; 2000. Technical Report Series: 894.; Colombia. Ministerio de Salud y Protección Social. Guía de Práctica Clínica (GPC) para la prevención,diagnóstico y tratamiento de la obesidad en adultos. Guia No. 52. Bogotá D.C.: MinSalud; 2016 [cited 2017 Jun 19]. Available from: https://goo.gl/yh84zp.; Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. JAMA. 2014;312(9):923-33. http://doi.org/bntk.; Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279-90. http://doi.org/qxq.; Gudzune KA, Doshi RS, Mehta AK, Chaudhry ZW, Jacobs DK, Vakil RM, et al. Efficacy of commercial weight-loss programs. An updated systematic review. Ann Intern Med. 2015;162(7):501-12. http://doi.org/bns8.; Figueroa A, Vicil F, Sánchez-González MA, Wong A, Ormsbee MJ, Hooshmand S, et al. Effects of diet and/or low-intensity resistance exercise training on arterial stiffness, adiposity, and lean mass in obese postmenopausal women. Am J Hypertens. 2013;26(3):416-23. http://doi.org/bntm.; Potteiger JA, Claytor RP, Hulver MW, Hughes MR, Carper MJ, Richmond S, et al. Resistance exercise and aerobic exercise when paired with dietary energy restriction both reduce the clinical components of metabolic syndrome in previously physically inactive males. Eur J Appl Physiol. 2012;112(6):2035-44. http://doi.org/csdvmz.; Dobrosielski DA, Patil S, Schwartz AR, Bandeen-Roche K, Stewart KJ. Effects of exercise and weight loss in older adults with Obstructive Sleep Apnea. Med Sci Sports Exerc. 2015;47(1):20-6. http://doi.org/bnsm.; American College of Sports Medicine. Exercise is medicine. Indianapolis: American College of Sports Medicine; 2017 [cited 2017 Apr 28]. Available from: http://goo.gl/r5lKje.; Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(9):709-23. http://doi.org/dfbtmp.; Dombrowski SU, Knittle K, Avenell A, Araújo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ. 2014;348(6):g2646. http://doi.org/bntn.; Apovian CM, Aronne LJ, Bessesen DH, McDonnell ME, Murad MH, Endocrine Society, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342-62. http://doi.org/f6862v.; Mikler R, Guevara C, Asociación Colombiana de Obesidad y Cirugía Bariátrica, editors. Guías de manejo en cirugía bariátrica. Bogotá: Distribuna Editorial; 2014.; Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Swedish Obese Subjects Study, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741-52. http://doi.org/bxbs7m.; Nguyen NT, Hinojosa M, Fayad C, Varela E, Wilson SE. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers. J Am Coll Surg. 2007;205(2):248-55. http://doi.org/d9p573.; Sundbom M. Laparoscopic revolution in bariatric surgery. World J Gastroenterol. 2014;20(41):15135-43. http://doi.org/f25nqb.; Hutter MM, Schirmer BD, Jones DB, Ko CY, Cohen ME, Merkow RP, et al. First Report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410-22. http://doi.org/c7kdgn.; Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621-35. http://doi.org/ddv2d6.; Consensus Development Conference Panel. NIH conference. Gastrointestinal surgery for severe obesity. Ann Intern Med. 1991;115(12):956-61. http://doi.org/bntp.; Cummings DE, Cohen RV. Beyond BMI: the need for new guidelines governing the use of bariatric and metabolic surgery. Lancet Diabetes Endocrinol. 2014;2(2):175-81. http://doi.org/f2qpx9.; Reed K, Pengo MF, Steier J. Screening for sleep-disordered breathing in a bariatric population. J Thorac Dis. 2016;8(2):268-75. http://doi.org/b6g3.; Morino M, Toppino M, Garrone C. Disappointing long-term results of laparoscopic adjustable silicone gastric banding. Br J Surg. 1997;84(6):868-9. http://doi.org/ftqmcn.; Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3-60 month follow-up. Obes Surg. 2000;10(3):233-9. http://doi.org/dvk528.; Nguyen NQ, Game P, Bessell J, Debreceni TL, Neo M, Burgstad CM, et al. Outcomes of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. World J Gastroenterol. 2013;19(36):6035-43. http://doi.org/bntq.; Spivak H, Abdelmelek MF, Beltran OR, Ng AW, Kitahama S. Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States. Surg Endosc. 2012;26(7):1909-19. http://doi.org/fx5vn8.; Gadiot RP, Grotenhuis BA, Biter LU, Dunkelgrun M, Zengerink HJ, Feskens PB, et al. Study protocol of the DUCATI-study: a randomized controlled trial investigating the optimal common channel length in laparoscopic gastric bypass for morbid obese patients. BMC Obes. 2015;2(1):28. http://doi.org/bntr.; Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight losss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122(6):535-42. http://doi.org/bgws6x.; Collen J, Lettieri CJ, Eliasson A. Postoperative C-PAP use impacts long-term weight loss following bariatric surgery. J Clin Sleep Med. 2015;11(3):213-7. http://doi.org/bnts.; https://revistas.unal.edu.co/index.php/revfacmed/article/view/60090
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