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Diagnóstico y tratamiento de la apnea obstructiva del sueño: una revisión
Daniel J Gottlieb1,2,3, Naresh M Punjabi4
1Medical Service, VA Boston Healthcare System, Boston, Massachusetts.
JAMA
|April 15, 2020
Resumen
La apnea obstructiva del sueño (AOS) es común y aumenta con la obesidad. Existen tratamientos efectivos, pero la evidencia para reducir los eventos cardiovasculares es limitada, especialmente para los casos asintomáticos.
Área de la Ciencia:
- Medicina del sueño
- Salud cardiovascular
- Salud pública
Sus antecedentes:
- La apnea obstructiva del sueño (AOS) afecta a una parte significativa de la población, con una prevalencia creciente relacionada con el aumento de las tasas de obesidad.
- Los síntomas principales incluyen somnolencia diurna excesiva, aunque muchos pacientes permanecen asintomáticos.
- La AOS es un factor de riesgo importante para las enfermedades cardiovasculares y metabólicas.
Objetivo del estudio:
- Proporcionar una revisión actualizada sobre el diagnóstico y el tratamiento de la apnea obstructiva del sueño (AOS).
- Resaltar la comprensión actual del impacto de la AOS en la salud y las intervenciones disponibles.
Principales métodos:
- Revisión de la literatura actual sobre el diagnóstico y el tratamiento de la AOS.
- Análisis de los métodos de diagnóstico, incluidas las pruebas de apnea del sueño en el hogar.
- Evaluación de varias intervenciones terapéuticas para el SAO.
Principales resultados:
- La prueba de apnea del sueño en el hogar tiene una sensibilidad de aproximadamente el 80% para el diagnóstico de AOS.
- Los tratamientos efectivos incluyen cambios en el estilo de vida, presión positiva de las vías respiratorias (PAP), aparatos orales, cirugía y estimulación del nervio hipogloso.
- La terapia de PAP puede reducir la presión arterial, particularmente en la hipertensión resistente, pero los ensayos grandes no han mostrado una reducción significativa de eventos cardiovasculares.
Conclusiones:
- La AOS es una condición prevalente que requiere estrategias de manejo efectivas.
- Si bien los tratamientos como el PAP pueden mejorar los síntomas y reducir la presión arterial, faltan pruebas de alta calidad que apoyen su uso para prevenir eventos cardiovasculares en todos los pacientes con AOS, especialmente en los asintomáticos.
- Se recomiendan intervenciones conductuales para pacientes con AOS asintomática o mínimamente sintomática.
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