Support groups appear to be an important adjunct for patients who undergo LAGB, to achieve and maintain improved weight loss.

Obstructive sleep apnea (OSA) is a sleep disorder characterized by recurrent episodes of closure of the upper airway during sleep, and is highly prevalent among overweight individuals. A significant percentage of patients with OSA remain undiagnosed. This condition creates chronic nighttime hypoxemia that can result in significant complications including systemic and pulmonary hypertension, cor pulmonale, and stroke. Polysomnography is still the most widely used method for diagnosing OSA. Studies have shown that in the majority of patients with OSA the airway obstruction involves the retroglossal region. Upon performing esophagogastroduodenoscopy on patients with a wide range of body mass indices (from 21 to 63), we noticed a gradual increase in the concavity of the posterior epiglottal surface as the BMI increases. Upon following some of the patients who underwent laparoscopic gastric banding and lost significant weight, we noticed a dramatic change in the shape of the epiglottis. This reflects a relief in the pressure on the epiglottis created by the collapsing airways in periods of apnea. Thus, the deformity in the shape of the epiglottis reflects the chronic airway collapse in obese patients, and improvement in this deformity after weight loss indicates a relief of the chronic upper airway obstruction.

No abstract

The incidence of Obstructive Sleep Apnea (OSA) is increasing with the rise in the prevalence of obesity in the population. Upon performing esophagogastroduodenoscopy (EGD) on more than 50 patients with BMI ranging from 21 to 63, we noticed an increase in the concavity of the posterior surface of the epiglottis in correlation with the increase in BMI. Since OSA is caused by collapse of the airways, this same pressure seems to be responsible for the deformity of the epiglottis, which normally has a minimally concave posterior surface. Therefore the shape of the epiglottis reflects the degree of airway collapse and thus the severity of OSA. We recommend that patients with increased concavity of the posterior epiglottal surface seen endoscopically should be tested for OSA.