Bariatric Surgery in the Treatment of Obstructive Sleep Apnea in Morbidly Obese Patients

Abstract

Background: Weight loss has been shown effective in the treatment of the obstructive sleep apnea-hypopnea syndrome. Regrettably, many obese patients are unable to achieve sustained and useful weight loss by dietary means. Recently, bariatric surgery has emerged as an alternative to treat obesity and many of its comorbidities, although its role for sleep apnea treatment is still not defined. Objectives: To evaluate the impact of bariatric surgery on obstructive sleep apnea in morbidly obese patients. Methods: In this cohort study, polysomnography, Epworth Sleepiness Scale questionnaire and clinical assessment were performed in 12 of 13 morbidly obese patients with moderate to severe obstructive sleep apnea treated with bariatric surgery through Roux-en-Y gastric bypass procedure after a minimum of 18 months post surgery. Results: The mean (±SD) loss of excess body weight was 70.5 ± 24%. The mean level obtained in the Epworth Scale was 4.8. There was a significant reduction in the apnea-hypopnea index, from a median of 46.5 (range: 33–140) to 16 (range: 0.9–87) events per hour (p < 0.05), an improvement in mean oxygen saturation from 85.7 ± 5.1 to 94.5 ± 3.6% (p < 0.05) and in minimum oxygen saturation from 64.7 ± 13.4 to 78.7 ± 13.7% (p < 0.05). The magnitude of the weight loss and the improvements in mean and minimum oxygen saturation were positively correlated, (r = 0.76; p ≤ 0.05, and r = 0.59; p ≤ 0.05, respectively). Conclusions: Weight loss achieved by bariatric surgery is associated with significant long-term improvements in obstructive respiratory event, oxygenation and resolution of daytime somnolence.

Risk factors and treatment for obstructive sleep apnea amongst obese children and adults

“…Peluso and Vanek [46] report that gastric bypass surgery resolved OSA in 75% of obese patients over a 3.6-30.6-month follow-up period. Fritscher et al [47] report resolved OSA in 25% of morbidly obese patients, and significant reduction in severity amongst 75% who had undergone gastric bypass surgery. In the same study, magnitude of weight loss was strongly associated with improved oxygen saturation indices.…”

Obstructive Sleep Apnea–Hypopnea Syndrome—The Role of Bariatric and Maxillofacial Surgeries

“…Surgical treatment, in addition, is the only intervention proven to maintain weight reduction in severely obese patients for the longer term (over 10 years). Improvement in OSAHS symptoms with reduction in AHI in severely obese patients after bariatric surgery has been well-documented [2,[5][6][7]33].…”

“…Bariatric surgery offers extensive, rapid, and sustained weight loss, usually providing excellent long-term results in the reduction of commonly associated comorbidities [2]. The weight loss achieved by bariatric surgery provides substantial benefits to morbidly obese patients with severe OSAHS and these benefits include significant AHI reductions with improvement in overnight oxygenation and an end to daytime sleepiness [5].…”

“…Numerous studies have confirmed that obesity is one of the strongest risk factors for the development of OSAHS [5][6][7]. In the case of morbidly obese patients, this association is much more evident with a prevalence of sleep apnea detected in 93.6% of cases [3].…”

Sleep apnoea and nutrition

“…New Study 2 shows that this does in fact work, and is consistent with other trials 10,11 , although it is also true that weight loss does not guarantee long term improvement -there remains a fair degree of variability between individuals in regard to OSA 12 . The methods used to achieve such weight loss in the various reported trials are similar to those used to treat obesity generally, including bariatric surgery and VLCDs 13,14 , and there is nothing in the literature to suggest there is anything specific about OSA in this regard.…”