Distúrbio do sono pode ser descoberto na cadeira do dentista

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Baixa saturação de oxigênio no cérebro durante o sono, com risco de morte, foi diagnosticada devido a checkup bucal

Por Paula Pereira – Ascom/UPPERPR (sistemas@comuniquese5.com.br)

Em um checkup bucal em uma clínica em São Paulo, o empresário Gerson Gitirana descobriu que a sua dificuldade para dormir escondia um problema grave de saúde. Não era cansaço, estresse ou outro motivo. No checkup, o empresário descobriu um ‘colapso da língua anteroposterior’ em estágio avançado.

O que significa isso? A princípio, a língua estava “caída” em sua faringe, o que obstruía as vias aéreas superiores durante o sono. O resultado levou a outro exame, dessa vez a Sonoedoscopia, que avaliou a anatomia da via aérea superior durante o período de descanso. Nesse resultado foi revelada uma saturação de oxigênio de 53% durante o sono – o normal é de 95%.

“Gerson praticamente não respirava dormindo e estava correndo o risco de ter uma parada cardíaca ou um AVC nesse período”, conta Marcelo Kyrillos, cirurgião-dentista do Ateliê Oral, que descobriu o caso e acompanhou o tratamento.

“Conversei com todos os meus médicos: clínico geral, cardiologista, da medicina ortomolecular, e todos eles falaram: ‘Cara, você vai morrer. Com essa saturação, você tem, no máximo, um ano de vida”, conta o empresário.

Com o diagnóstico de Apneia Obstrutiva do Sono (AOS) já grave, Gerson passou a dormir com um aparelho [CPAP] que fornecia ar sob pressão para as vias aéreas, o que seria temporário até o final do tratamento.

A descoberta

O dentista conta que tudo partiu de um checkup específico da clínica, no qual foram feitas fotografias da face e o escaneamento dos dentes, para a avaliação da harmonia das bases ósseas. Como parte do processo, também foi pedida uma tomografia – um exame esquelético 3D para avaliar os maxilares e os dentes. “Isso é de praxe, não havia nenhum sintoma. O paciente não havia falado que tinha problemas ao dormir”, destaca Kyrillos.

No entanto, com os resultados em mãos foi possível identificar que, tanto o maxilar superior quanto o inferior do paciente, estavam para trás pressionando uma região chamada ‘Orofaring’ por onde passa o ar até os pulmões – o ar entra pelo maxilar e vai para os pulmões. “No caso do Gerson, a queda da língua foi um agravante pelo relaxamento excessivo dos músculos da garganda durante o sono. Ao dormir, todos os músculos do corpo relaxam, incluindo os da língua e da garganta. Em pessoas com AOS (Apneia Obstrutiva do Sono), esse relaxamento pode ser excessivo, permitindo que a língua deslize para trás e bloqueie a passagem do ar”, detalha Kyrillos.

O passo seguinte foi envolver outros profissionais da clínica para a avaliação da mordida, que também estava prejudicada, e para análises complementares do esqueleto bucal.

Foi, então, recomendada uma Sonoendoscopia – exame que avalia a anatomia da via aérea superior durante o sono induzido e que permite visualizar diretamente onde e como ocorrem as obstruções. O exeme culminou no veredito final: baixa saturação e obstruções físicas nas vias aéreas que explicavam a queda do oxigênio. “Nesse exame, o paciente fica dormindo de barriga para cima e são realizadas projeções de como ocorreria a respiração, neste caso, são realizadas projeções de como ocorreria a respiração se a mandíbula fosse posicionada de forma diferente. Ao colocar mais para a frente, observamos o aumento acentuado de entrada de oxigênio por aquela passagem. Ali, soubemos exatamente o que deveria ser feito”, conta Kyrillos.

O tratamento: saturação de oxigênio passou de 53% para 98%

De acordo com o dentista, o tratamento consistia em colocar os dentes na posição correta dentro do osso, e os maxilares na posição correta, de acordo com o crânio, permitindo a Gerson respirar.

Para isso, o empresário usou um aparelho ortodôntico, com miniplacas e retirada de sisos, para corrigir a mordida e o alinhamento dentário. Tal correção, também permitiu fazer o avanço da mandíbula. Feito isso, foi realizada uma cirurgia [chamada de ortognática] para corrigir as bases ósseas e permitir que as vias aéreas fossem desobstruídas. E, por fim, colocadas lentes dentais para a correção das engrenagens dos dentes.

“O impacto foi imediato. A saturação de oxigênio no cérebro passou de 53% para 98% durante o sono. Hoje durmo bem e considero uma sorte ter descoberto. Não havia sintomas, apenas minhas noites de sono mal dormidas. Por isso, considero todo checkup, desde que seja detalhado como o realizado em mim, uma oportunidade de me deixar seguro, pois me livrou do que poderia ter sido uma parada cardíaca ou outro mal fatal”, avalia Gerson.

Kyrillos destaca que, além das causas diagnósticadas pelo paciente (maxilares para trás e queda da língua), a AOS pode ser causada (ou combinada) por outros fatores, tais como: anormalidades anatômicas – como amígdalas aumentadas, desvio de septo nasal ou um palato mole alongado, e excesso de tecido adiposo na região do pescoço. Obesidade, consumo de álcool e sedativos, idade avançada são outros fatores contribuintes.

A seguir, imagem de Apneia Obstrutiva do Sono (AOS) acometida pelo paciente. Importante destacar que a imagem representa uma das causas da Apneia Obstrutiva do Sono (AOS), que é a queda da língua. Porém, a AOS é uma condição complexa e multifatorial, e a queda da língua é apenas um dos fatores que podem contribuir para a obstrução das vias aéreas.

Ela demonstra:

Na respiração normal – a via aérea permanece aberta, permitindo a passagem do ar.

Na outra opção: Apneia Obstrutiva – A língua relaxada obstruindo a via aérea e impedindo a passagem do ar.

Foto: Reprodução/https://aapi.org.br/

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