Cirurgia bariátrica e apnéia do sono

Abstract

Obesity is an important medical and social problem due to its severity and its already high and increasing prevalence. It has epidemic proportions and can cause or worsen arterial hypertension, type 2 diabetes mellitus, degenerative arthropathies, sleep apnea, as well as respiratory and cardiovascular dysfunctions. The impairment of the quality of life, reduction of life expectancy and the high failure rates of medical treatment are factors which reinforce the indication of surgical treatment for morbid obesity. The surgical indication is based on the analysis of multiple clinical aspects, including conservative treatment failure and psychological evaluation. Body mass index higher than 40 kg/m2, or over 35 kg/m2 with the presence of illness associated with obesity are important parameters to define the surgical indication. Surgical techniques involve modalities that are restrictives, malabsortives or a combination of both. As is the case for other comorbidities, an adequate pre and postoperative preparation of obese patients with severe obstructive sleep apnea is important. Besides special care concerning ventilation, it is recommended that the patient looses 10 to 15% of his original weight before the surgical operation. The preferencial surgical technique for morbid obesity in Brazil is the vertical gastroplasty with bandage and Roux-en-Y gastric bypass (Fobi-Capella operation) as it obtains a long-term weight loss of 40% of the original body weight, without significant nutritional and metabolic alterations. Bariatric surgery cures or improves most of the obese patients suffering from sleep apnea.