[Acute respiratory failure immediately following surgery for morbid obesity]. / Insuficiencia respiratoria aguda en el postoperatorio inmediato de cirugía por obesidad mórbida.

Patients with sleep apnea-hypopnea syndrome have a higher probability of presenting more postoperative complications, yet early treatment with continuous positive airway pressure can prevent them. We report the case of a patient who underwent surgery for morbid obesity and who developed acute respiratory failure in the immediate postoperative period, requiring readmission to the recovery unit. The patient's condition progressed favorably following treatment with bilevel positive airway pressure. It was subsequently confirmed that the patient suffered from sleep apnea-hypopnea syndrome.

Association of chronic obstructive pulmonary disease and obstructive sleep apnea consequences.

Obstructive sleep apnea syndrome (OSAS) and chronic obstructive pulmonary disease (COPD) are two diseases that often coexist within an individual. This coexistence is known as overlap syndrome and is the result of chance rather than a pathophysiological link. Although there are claims of a very high incidence of OSAS in COPD patients, recent studies report that it is similar to the general population. Overlap patients present sleep-disordered breathing associated to upper and lower airway obstruction and a reduction in respiratory drive. These patients present unique characteristics, which set them apart from either COPD or OSAS patients. COPD and OSAS are independent risk factors for cardiovascular events and their coexistence in overlap syndrome probably increases this risk. The mechanisms underlying cardiovascular risk are still unclear, but may involve systemic inflammation, endothelial dysfunction, and tonic elevation of sympathetic neural activity. The treatment of choice for overlap syndrome in stable patients is CPAP with supplemental oxygen for correction of upper airway obstructive episodes and hypoxemia during sleep.