Dados do Trabalho

Título

Hepatic steatosis in preoperative bariatric surgery patients with obstructive sleep apnea

Introdução

Obstructive sleep apnea (OSA) is a global burden disease with increasing incidence associated to obesity incidence, along with its comorbidities, the main one being metabolic syndrome. Characterized by recurrent upper airway obstruction during sleep results in hypoxemia cycles. Obesity is the main risk factor for OSA. Intermittent hypoxemia resulting from OSA may lead to increased insulin resistance and a change in lipid metabolism, which may precipitate hepatic steatosis.

Objetivo

To evaluate the association of hepatic steatosis in patients undergoing preoperative evaluation of bariatric surgery diagnosed with OSA.

Métodos

Retrospective study, with data collected from 1.416 preoperative bariatric private services, from which ultrasound (US) and polysomnography (PSG) data were obtained, resulting in 87 OSA cases. Anthropometric data, grade of hepatic steatosis according to US and PSG data were collected.

Resultados

The average age was 39.5 (sd ± 11.4); 60% of sample was women. The body mass index (BMI) was 39.2 (s.d. ± 4.45); slow wave sleep (SWS) was 12.5 (sd 12.5); REM sleep was 16.2 (sd ± 7.1); of the micro-arousals was 39.1 (sd ± 25.4); the apnea and hypoapnea index (AHI) was 33.5 (sd ± 38.9); minimum saturation was 73.9 (sd 9.8); saturation below 90% was 23.1 (sd ± 27.2); oxygen desaturation index (ODI) was 41.3 (sd ± 34.1), sex (p> 0.002). Spliting the AHI by severity where AHI < 15 or AHI >15, we respectively found 36% and 64%. The steatosis grade differs by AHI severity (p<0.001) and sex (p<0.001). Of all women evaluated, 20.7% had no steatosis, 33.9% grade 1, 37.7% grade 2 and 7.54% grade 3. There was a difference between the apnea severity groups for age (p = 0.0018), slow wave sleep (SWS; p = 0.027), REM (p = 0.004), micro-arousals (p <0.001), minimum saturation (p = 0.005), ODI (<0.001). After adjusting several variables through multiple regression, only the female gender was a predictor of steatosis grade.

Conclusões

This study found a high prevalence of steatosis in OSA patients.The evaluation between the steatosis grade showed no difference for BMI and polysomnography data, but rather for OSA severity, gender and age, thus being female sex a independent predictor factor to steatoses grade.

Palavras-chave

Obstructive Sleep Apnea; hepatic steatosis; metabolic syndrome