Tratamiento quirúrgico de la apnea obstructiva del sueño más allá de lo habitual: traqueotomía y ciguría bariátrica
Resumen Introducción y objetivo: Históricamente, la traqueotomía fue el primer tratamiento con intención curativa de la apnea obstructiva del sueño (AOS). Sin embargo, supone unas secuelas que los pacientes difícilmente aceptan, por lo que actualmente apenas se realiza en la actualidad. Por otro lado, además de la cirugía de la vía aérea superior, cuando la obesidad es severa, con un índice de masa corporal (IMC)>35, la cirugía bariátrica se convierte en el mejor tratamiento quirúrgico de la AOS siendo creciente su indicación actual. Síntesis: Presentamos un resumen histórico del papel de la traqueotomía en la AOS y una perspectiva actual de las técnicas de cirugía bariátrica que son útiles en la AOS. Conclusiones: En la actualidad, la traqueotomía sólo tiene indicaciones muy excepcionales en pacientes con AOS. En pacientes con AOS severa (IAH>30) y obesidad con IMC >35, el tratamiento quirúrgico más adecuado de la enfermedad es la cirugía bariátrica cuando haya intolerancia a la CPAP.
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Kim SH, Eisele DW, Smith PL, Schneider H, Schwartz AR. Evaluation of patients with sleep apnea after tracheotomy. Arch Otolaryngol Head Neck Surg. 1998 Sep;124(9):996-1000.
Conway WA, Victor LD, Magilligan DJ Jr, Fujita S, Zorick FJ, Roth T. Adverse effects of tracheostomy for sleep apnea. JAMA. 1981 Jul 24-31;246(4):347-50.
Stradling JR. Avoidance of tracheostomy in sleep apnoea syndrome. Br Med J (Clin Res Ed). 1982 Aug 7;285(6339):407-8.
Mattox DE, Gates GA. Alternatives to tracheostomy in sleep apnea. N Engl J Med. 1983 Mar 17;308(11):656..
Camacho M, Certal V, Brietzke SE, Holty JE, Guilleminault C, Capasso R. Tracheostomy as treatment for adult obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2014;124(3):803-11.
Fray S, Biello A, Kwan J, Kram YA, Lu K, Camacho M. Tracheostomy for paediatric obstructive sleep apnoea: A systematic review. J Laryngol Otol 2018;132(8):680-4.
He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988;94:9-14.
Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest 1988;94:1200-4.
Haapaniemi JJ, Laurikainen EA, Halme P, Antila J. Long-term results of tracheostomy for severe obstructive sleep apnea syndrome. ORL J Otorhinolaryngol Relat Spec 2001;63:131–136.
Fletcher EC. Recurrence of sleep apnea syndrome following tracheostomy. A shift from obstructive to central apnea. Chest 1989;96:205–209.
Kumar A, Camacho M, Capasso R. Quantitative assessment of an obstructive sleep apnea patient before and after tracheostomy: a case study. J Otol Rhinol. 2013;2(2):15-18.
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Carneiro-Barrera A, Díaz-Román A, Guillén-Riquelme A, Buela-Casal G. Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: Systematic review and meta-analysis. Obes Rev. 2019 May;20(5):750-762..
Chen JL, Moon TS, Schumann R. Bariatric surgery in patients with obstructive sleep apnea. Int Anesthesiol Clin. 2022 Apr 1;60(2):50-58..
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 Mar;23(3):414-23..
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37.
Ming X, Yang M, Chen X. Metabolic bariatric surgery as a treatment for obstructive sleep apnea hypopnea syndrome: review of the literature and potential mechanisms. Surg Obes Relat Dis. 2021 Jan;17(1):215-220.
Dixon JB, Schachter LM, O'Brien PE, Jones K, Grima M, Lambert G, Brown W, Bailey M, Naughton MT. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012 Sep 19;308(11):1142-9.
Fredheim JM, Rollheim J, Sandbu R, Hofsø D, Omland T, Røislien J, Hjelmesæth J. Obstructive sleep apnea after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention. J Clin Sleep Med. 2013 May 15;9(5):427-32.
Kang JH, Le QA. Effectiveness of bariatric surgical procedures: A systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017 Nov;96(46):e8632..
Hayoz C, Hermann T, Raptis DA, Brönnimann A, Peterli R, Zuber M. Comparison of metabolic outcomes in patients undergoing laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy - a systematic review and meta-analysis of randomised controlled trials. Swiss Med Wkly. 2018 Jul 5;148:w14633..
Guardiano SA, Scott JA, Ware JC, Schechner SA. The long-term results of gastric bypass on indexes of sleep apnea. Chest. 2003 Oct;124(4):1615-9.
Feigel-Guiller B, Drui D, Dimet J, Zair Y, Le Bras M, Fuertes-Zamorano N, Cariou B, Letessier E, Nobécourt-Dupuy E, Krempf M. Laparoscopic Gastric Banding in Obese Patients with Sleep Apnea: A 3-Year Controlled Study and Follow-up After 10 Years. Obes Surg. 2015 Oct;25(10):1886-92..
Peromaa-Haavisto P, Tuomilehto H, Kössi J, Virtanen J, Luostarinen M, Pihlajamäki J, Käkelä P, Victorzon M. Obstructive sleep apnea: the effect of bariatric surgery after 12 months. A prospective multicenter trial. Sleep Med. 2017 Jul;35:85-90.
Zhao Y, Li T, Zhang G, Liang X, Wang Y, Kang J, Ma J. Bariatric surgery reduces sleep apnea in obese patients with obstructive sleep apnea by increasing pharyngeal cross-sectional area during the early postoperative period. Eur Arch Otorhinolaryngol. 2023 May;280(5):2435-2443..
van Zeller C, Brown R, Cheng M, Meurling J, McGowan B, Steier J. Peri-operative outcomes of bariatric surgery in obstructive sleep apnoea: a single-centre cohort study. J Thorac Dis. 2023 Feb 28;15(2):802-811.
Kuhlo W, Doll E, Franc MC. Exfolgreiche behandlung eines Pickwick Syndrom durch eine dauertracheal kanule. Dtsch Med Wochenschr. 1969;94:1286-90.
Tilkian AG, Guilleminault C, Schroeder JS, Lehrman KL, Simmons FB, Dement WC. Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med. 1977 Sep;63(3):348-58.
Guilleminault C, Simmons FB, Motta J, Cummiskey J, Rosekind M, Schroeder JS, Dement WC. Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up experience. Arch Intern Med. 1981 Jul;141(8):985-8.
Kim SH, Eisele DW, Smith PL, Schneider H, Schwartz AR. Evaluation of patients with sleep apnea after tracheotomy. Arch Otolaryngol Head Neck Surg. 1998 Sep;124(9):996-1000.
Conway WA, Victor LD, Magilligan DJ Jr, Fujita S, Zorick FJ, Roth T. Adverse effects of tracheostomy for sleep apnea. JAMA. 1981 Jul 24-31;246(4):347-50.
Stradling JR. Avoidance of tracheostomy in sleep apnoea syndrome. Br Med J (Clin Res Ed). 1982 Aug 7;285(6339):407-8.
Mattox DE, Gates GA. Alternatives to tracheostomy in sleep apnea. N Engl J Med. 1983 Mar 17;308(11):656..
Camacho M, Certal V, Brietzke SE, Holty JE, Guilleminault C, Capasso R. Tracheostomy as treatment for adult obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2014;124(3):803-11.
Fray S, Biello A, Kwan J, Kram YA, Lu K, Camacho M. Tracheostomy for paediatric obstructive sleep apnoea: A systematic review. J Laryngol Otol 2018;132(8):680-4.
He J, Kryger MH, Zorick FJ, Conway W, Roth T. Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. Chest 1988;94:9-14.
Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. Chest 1988;94:1200-4.
Haapaniemi JJ, Laurikainen EA, Halme P, Antila J. Long-term results of tracheostomy for severe obstructive sleep apnea syndrome. ORL J Otorhinolaryngol Relat Spec 2001;63:131–136.
Fletcher EC. Recurrence of sleep apnea syndrome following tracheostomy. A shift from obstructive to central apnea. Chest 1989;96:205–209.
Kumar A, Camacho M, Capasso R. Quantitative assessment of an obstructive sleep apnea patient before and after tracheostomy: a case study. J Otol Rhinol. 2013;2(2):15-18.
Mediano O, González Mangado N, Montserrat JM, Alonso-Álvarez ML, Almendros I, Alonso-Fernández A, et al. International Consensus Document on Obstructive Sleep Apnea. Arch Bronconeumol. 2022 Jan;58(1):52-68. English, Spanish.
Joosten SA, Hamilton GS, Naughton MT. Impact of Weight Loss Management in OSA. Chest 2017;152:194–203..
Hudgel DW, Patel SR, Ahasic AM, Bartlett SJ, Bessesen DH, Coaker MA, et al. The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Sep 15;198(6):e70-e87..
Carneiro-Barrera A, Díaz-Román A, Guillén-Riquelme A, Buela-Casal G. Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: Systematic review and meta-analysis. Obes Rev. 2019 May;20(5):750-762..
Chen JL, Moon TS, Schumann R. Bariatric surgery in patients with obstructive sleep apnea. Int Anesthesiol Clin. 2022 Apr 1;60(2):50-58..
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 Mar;23(3):414-23..
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004 Oct 13;292(14):1724-37.
Ming X, Yang M, Chen X. Metabolic bariatric surgery as a treatment for obstructive sleep apnea hypopnea syndrome: review of the literature and potential mechanisms. Surg Obes Relat Dis. 2021 Jan;17(1):215-220.
Dixon JB, Schachter LM, O'Brien PE, Jones K, Grima M, Lambert G, Brown W, Bailey M, Naughton MT. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012 Sep 19;308(11):1142-9.
Fredheim JM, Rollheim J, Sandbu R, Hofsø D, Omland T, Røislien J, Hjelmesæth J. Obstructive sleep apnea after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention. J Clin Sleep Med. 2013 May 15;9(5):427-32.
Kang JH, Le QA. Effectiveness of bariatric surgical procedures: A systematic review and network meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017 Nov;96(46):e8632..
Hayoz C, Hermann T, Raptis DA, Brönnimann A, Peterli R, Zuber M. Comparison of metabolic outcomes in patients undergoing laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy - a systematic review and meta-analysis of randomised controlled trials. Swiss Med Wkly. 2018 Jul 5;148:w14633..
Guardiano SA, Scott JA, Ware JC, Schechner SA. The long-term results of gastric bypass on indexes of sleep apnea. Chest. 2003 Oct;124(4):1615-9.
Feigel-Guiller B, Drui D, Dimet J, Zair Y, Le Bras M, Fuertes-Zamorano N, Cariou B, Letessier E, Nobécourt-Dupuy E, Krempf M. Laparoscopic Gastric Banding in Obese Patients with Sleep Apnea: A 3-Year Controlled Study and Follow-up After 10 Years. Obes Surg. 2015 Oct;25(10):1886-92..
Peromaa-Haavisto P, Tuomilehto H, Kössi J, Virtanen J, Luostarinen M, Pihlajamäki J, Käkelä P, Victorzon M. Obstructive sleep apnea: the effect of bariatric surgery after 12 months. A prospective multicenter trial. Sleep Med. 2017 Jul;35:85-90.
Zhao Y, Li T, Zhang G, Liang X, Wang Y, Kang J, Ma J. Bariatric surgery reduces sleep apnea in obese patients with obstructive sleep apnea by increasing pharyngeal cross-sectional area during the early postoperative period. Eur Arch Otorhinolaryngol. 2023 May;280(5):2435-2443..
van Zeller C, Brown R, Cheng M, Meurling J, McGowan B, Steier J. Peri-operative outcomes of bariatric surgery in obstructive sleep apnoea: a single-centre cohort study. J Thorac Dis. 2023 Feb 28;15(2):802-811.
Plaza-Mayor, G., O’Connor-Reina, C., Baptista-Jardin, P. M., Marco-Garrido, A., Carrasco-Llatas, M., & Martínez-Ruiz de Apodaca, P. (2023). Tratamiento quirúrgico de la apnea obstructiva del sueño más allá de lo habitual: traqueotomía y ciguría bariátrica. Revista ORL, e30979. https://doi.org/10.14201/orl.30979
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