Bariatric surgery in morbidly obese sleep-apnea patients: short- and long-term follow-up

Charuzi, I; Lavie, Peretz; Peiser, Jochanan; Peled, Ron

doi:10.1093/ajcn/55.2.594s

Cited by 145 publications

(48 citation statements)

References 11 publications

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“…Especially, the SOS study 55,74,[98][99][100] demonstrated fewer days due to sick leave in the operated group compared to the conservatively treated control group during the second and fourth year postsurgery. The positive changes of econometric findings do not only result from the psychosocial improvements described in this review, but also from a considerable decrease of obesity-related risk-factors reflected for example by significant improvements in type II diabetes, 107,114 sleepapnoe, 115 and joint diseases. Interestingly enough, 10-y data of SOS show that blood pressure was not improved by surgical treatment.…”

Section: Discussionmentioning

confidence: 71%

Does obesity surgery improve psychosocial functioning? A systematic review

Herpertz¹,

Kielmann²,

et al. 2003

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OBJECTIVE:The objective of this study is to present a review of the psychosocial outcome of bariatric surgery with special consideration of psychiatric comorbidity, psychopathology, psychosocial functioning, econometric data, and general quality of life (QoL). PURPOSE: A review of all (non-) controlled trials of the last two decades both with a retrospective and prospective design and a follow-up period of at least 1 y. RESEARCH METHODS AND PROCEDURES:The relevant literature was identified by a search of computerized databases. All articles published in English and German since 1980 were reviewed. Based on the requirements of the evidenced-based guidelines of the Agency for Health Care Policy and Research and the Scottish Intercollegiate Guidelines Network, each study was rated by a level of evidence. RESULTS: In all, 171 publications were reviewed. Using the above inclusion/exclusion criteria, 63 articles including two systematic reviews were identified. A total of 40 studies focused on psychosocial outcome after obesity surgery. CONCLUSION: Mental health and psychosocial status including social relations and employment opportunities improve for the majority of people after bariatric surgery thus leading to an improved QoL. Psychiatric comorbidity, predominantly affective disorders, and psychopathologic symptoms decrease postsurgically. A substantial percentage of bariatric surgery patients suffer from binge eating disorder or binge eating symptoms. The effect of bariatric surgery on the outcome of binge eating symptoms largely depends on the type of operation. With the exception of patients with a severe psychiatric comorbidity, the concern that obesity surgery will reinforce psychic symptoms and lead to a reduction in the QoL seems to be unfounded.

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Section: Discussionmentioning

confidence: 71%

Does obesity surgery improve psychosocial functioning? A systematic review

Herpertz¹,

Kielmann²,

et al. 2003

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“…In recent years, bariatric surgical procedures have been increasingly used for the treatment of severe obesity. These procedures combine gastric restriction and/or intestinal bypass to induce early satiety and nutrient malabsorbtion, respectively (35,(169)(170)(171)(172), and lead to an approximately 60% loss in excess body weight in the first 12 to 18 months postoperatively (173)(174)(175)(176)(177)(178)(179)(180)(181)(182)(183)(184)(185). In a recent meta-analysis of bariatric studies involving 22,094 patients, Buchwald and colleagues (11) Improvements in sleep apnea with weight loss have been related to effects of adiposity on upper airway function during sleep.…”

Section: Weight Loss Sleep Apnea and Upper Airway Functionmentioning

confidence: 99%

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

Schwartz

Patil²,

Laffan

et al. 2008

Proceedings of the American Thoracic Society

584

395

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Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system-acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of upper airway collapsibility, which determine sleep apnea susceptibility. Although weight loss reduces upper airway collapsibility during sleep, it is not known whether its effects are mediated primarily by improvement in upper airway mechanical properties or neuromuscular control. A variety of behavioral, pharmacologic, and surgical approaches to weight loss may be of benefit to patients with sleep apnea, through distinct effects on the mass and activity of regional adipose stores. Examining responses to specific weight loss strategies will provide critical insight into mechanisms linking obesity and sleep apnea, and will help to elucidate the humoral and molecular predictors of weight loss responses.

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“…10,11 Intentional weight loss reduces blood pressure and improves metabolic profile. 12 It also reduces the symptoms and/or improves the clinical findings in several obesityrelated chronic conditions, such as diabetes, 12 coronary heart disease, 13 asthma, 14,15 obstructive sleep apnoea, [16][17][18] and osteoarthrosis. 19,20 The marked weight loss achieved by surgical techniques has been associated with clear long-term improvements in HRQL.…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life in obese outpatients losing weight with very-low-energy diet and behaviour modification: a 2-y follow-up study

et al. 2003

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OBJECTIVE:To study health-related quality of life (HRQL) in a clinically selected sample obese outpatients. DESIGN: A single-strand before and after study with 2-y follow-up after treatment comprising 10 weeks on very-low-energy diet (VLED) and 4 months of behaviour modification in groups. SUBJECTS: A total of 126 patients (mean (s.d.) age 48.2 (11.1) y and body mass index (BMI) 42.8 (6.2) kg/m 2 (63% women)) referred for treatment in an obesity clinic. MEASUREMENTS: Weight and HRQL using questionnaires (RAND 36-Item Health Survey 1.0 and Obesity-related Psychosocial problems-scale). RESULTS: In all, 100 patients (61% women) completed the treatment and 67 (71% women) completed the 2-y follow-up. The mean (s.d.) weight loss was 12.5 (5.6)% at the end of group therapy, 6.0 (7.1)% at 1 y, and 2.6 (7.5)% at 2 y. At baseline, the mean (s.d.) score for OP-scale was 61.9 (24.6). The mean scores on every RAND-36 scale were markedly lower than in the Finns without chronic conditions. All the scales in HRQL improved markedly during the treatment. During the follow-up, all the scales started to return back towards baseline levels and at 2 y, only obesity-related psychosocial problems and physical functioning were still improved relative to baseline. In categories of weight change at 2 y (Z10% weight loss, 0-9.9% weight loss, weight gain), obesity-related psychosocial functioning, physical functioning, and general health showed dose-response improvement with increasing weight loss. A Z10% weight loss at 2 y after treatment was associated with clear improvement in obesity-related psychosocial problems, physical functioning, physical role functioning, bodily pain, general health, mental health, and vitality. A 0-9.9% weight loss was associated with improvement in obesity-related psychosocial problems and physical functioning. Weight gain was associated with improvement in obesity-related psychosocial problems and social functioning. The study population was too small to examine possible gender differences. CONCLUSIONS: Treatment with VLED and behaviour modification produces marked short-term weight loss and clear improvement in all aspects of HRQL. At 2 y after treatment, the average maintained weight loss is modest. However, one-third of patients maintain Z5% weight loss. Improvement in obesity-related psychosocial problems and physical functioning is associated even with o10% of maintained weight loss. Since the pattern of HRQL changes did only partly follow the pattern of weight change as expected, other factors, such as the therapeutic effect of participating in the weight loss programme or increase in physical activity, may affect HRQL responses.

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Bariatric surgery in morbidly obese sleep-apnea patients: short- and long-term follow-up

Cited by 145 publications

References 11 publications

Does obesity surgery improve psychosocial functioning? A systematic review

Does obesity surgery improve psychosocial functioning? A systematic review

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

Health-related quality of life in obese outpatients losing weight with very-low-energy diet and behaviour modification: a 2-y follow-up study

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