Bariatric surgery in patients with obstructive sleep apnea

Abstract

According to the most recent International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Worldwide Survey, there were 685,874 bariatric operations performed in 2016. 1 As the prevalence of obesity increases, the number of patients who undergo bariatric surgery will also continue to rise. Surgeons, anesthesiologists, and other perioperative providers need to be aware of important comorbidities associated with obesity, particularly obstructive sleep apnea (OSA), in order to decrease morbidity and mortality in patients undergoing bariatric surgery.Based on recent studies, the prevalence of OSA worldwide is nearing one billion persons. 2 The prevalence of OSA in the bariatric surgery population has been reported to be anywhere between 35% and 94%. 3 One study that performed polysomnography (PSG) on all patients before bariatric surgery found an OSA rate of 47%. 4 Thus, the actual prevalence of OSA may be higher than some estimates due to patients with undiagnosed OSA.Sleep-disordered breathing (SDB), which leads to a higher rate of pulmonary and cardiovascular complications in the postoperative period, is common in patients with obesity. 5 Examining the significance of OSA as a comorbidity in patients undergoing bariatric surgical procedures is of special interest due to the strong association between OSA and obesity. The majority of weight loss surgeries are performed using a minimally invasive laparoscopic approach, which has a lower complication rate compared with open procedures. 6 To minimize morbidity and mortality and optimize resource utilization, it is appropriate to determine the ideal preoperative screening tests, intraoperative management, and postoperative monitoring techniques for patients with OSA undergoing bariatric surgery.

Perinatal Outcomes Including Breastfeeding after Bariatric Surgery in Women with Grade 3 Obesity

“…OSA is a common sleep disorder in morbidly obese adults estimated to affect up to one billion people worldwide, while among patients scheduled for BS, the prevalence was found to be 60 percent [42][43]. In our investigation, OSA was more prevalent in the BS group and it was twice as common in the high than in the low BMI subgroup.…”

Tratamiento quirúrgico de la apnea obstructiva del sueño más allá de lo habitual: traqueotomía y ciguría bariátrica

“…Las razones fundamentales por la que las personas que sufren de obesidad también padezcan AOS son dos: en primer lugar, el aumento de los depósitos de grasa en los tejidos circundantes a la VAS, lo que provoca una disminución del diámetro de la misma, provocando que se colapse con mayor facilidad; en segundo lugar, el aumento de los depósitos de grasa alrededor del tórax, lo que reduce la capacidad de expansión del mismo, provocando un aumento en la demanda de oxígeno del cuerpo ya que reduce la capacidad pulmonar. Irónicamente, y para empeorar la situación, los pacientes con AOS tienen una predisposición a provocar obesidad ya que esta enfermedad aumenta el apetito y reduce la capacidad de la persona para mantenerse activo por la somnolencia tan severa que provoca [16,20,21].…”

“…Cuando la obesidad es severa, con IMC >35, es conveniente recurrir a tratamientos quirúrgicos de la misma, que además consiguen mejorías significativas en la AOS y sus consecuencias cardiovasculares y metabólicas [20][21][22][23]. Así, la cirugía bariátrica ha demostrado ser efectiva tanto en el tratamiento de la obesidad como en la AOS, y muy superior a las dietas [24,25].…”