Abstract 9460: Robotic Surgery in Obstructive Sleep Apnea Syndrome to Reduce the Cardiometabolic Risk in Hypertensive Patients
Introduction. It is confirmed the association between OSAS (Obstructive Sleep Apnea Syndrome) and increased cardiometabolic risk in obese hypertensive patients, determined by a multifactorial origin and by the activation of the adrenergic system. In the OSAS the apneas and arousals always end with a hypertensive peak that occurs in the phase of hypoventilation, altering the normal nocturnal Blood Pressure (BP) pattern that it is similar to the daytime pattern.
The aim of the study. Assess the reduction in BP, sleep apnea and metabolic parameters in hypertensive patients undergoing Robotic Surgery using TORS (Trans Oral Robotic Surgery) with Da Vinci Robot, compared to a control group subjected to CPAP (Continuous Positive Airway Pressure).
Materials and Methods. We enrolled 32 patients (20 M, 12 F, average age 53 years) hypertensive, undergoing therapy (average drugs taken 3.2) and obese (BMI > 30), with OSAS (diagnosed with polysomnography presenting AHI - Apnea-Hypopnea Index - > 30), with alterations in metabolic parameters (LDL > 156 mg/dL, glycated hemoglobin > 7.0 %), S02 < 85%, with Mean Arterial Pressure (MAP) of 136 mmHg during a 24 h BP monitoring (ABPM) with non-dipper profile, with ECG Heart Rate (HR) increase > 80, with values of NT pro-BNP (Brain Natriuretic Peptide N-terminal) > 500 pg/mL, and underwent TORS with the lingual tonsil resection, tonsillectomy and septoplasty. Also were compared with 30 patients, with similar demographic and clinical characteristics, who underwent CPAP.
Results. After 6 months we obtain an average reduction of AHI 5, improvement in metabolic parameters (LDL < 130 mg/dL, glycated hemoglobin < 6.0 %), the MAP has been reduced to 106 mmHg (profile dipper), the HR has been reduced to less than 60, and we have also observed a reduction of the NT pro-BNP values to < 300 pg/mL; also there was a reduction in therapy (2.2 drugs taken). While in the group with CPAP we only recorded S02 > 95%, MAP 120 and reduced AHI between 15 and 18.Conclusions. The TORS although an invasive surgical technique, but more specific and aesthetically better, has showed a significant reduction of AHI, cardiometabolic parameters and BP compared to the use of CPAP, contributing to greater therapeutic efficacy with reduced need for medications.
- © 2012 by American Heart Association, Inc.