Combined Airway and Bariatric Surgery (CABS) for Obstructive Sleep Apnea Patients with Morbid Obesity: A Comprehensive Alternative Preliminary Study

Abstract

Although continuous positive airway pressure is the gold standard for obstructive sleep apnea (OSA), it does not improve obesity. By contrast, bariatric surgery significantly improves obesity but with sustained OSA in the majority of patients. This study proposes a comprehensive technique—combined airway and bariatric surgery (CABS)—to improve both obesity and OSA. The aims of the study are to evaluate the feasibility, safety and efficacy of CABS in morbidly obese OSA patients. The retrospective study enrolled 20 morbidly obese OSA patients (13 males; median age, 44 years; median apnea–hypopnea index (AHI), 63.2 event/h; median body mass index (BMI), 41.4 kg/m2). The study population was divided into two groups based on patients’ volition after shared decision making. The bariatric surgery (BS) group included laparoscopic sleeve gastrectomy (LSG, n = 8) and laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 2). CABS involved bariatric surgery—LSG (n = 8) and LRYGB (n = 2) in conjunction with airway surgery (concurrent nasal/palatal/lingual surgery [n = 8], concurrent palatal/lingual surgery [n = 2]). Patients received a home sleep apnea test at baseline and one year after surgery. The two patient groups were not different in age, sex, preoperative AHI or preoperative BMI. There was no airway compromise, wound bleeding or infection throughout the postoperative period. One year after surgery, patients in both groups achieved significant improvement in AHI and BMI. Furthermore, the improvement in AHI was significantly higher (p = 0.04) in the CABS group than in the BS group despite the insignificant change in BMI reduction (p = 0.63) between the two groups. In the CABS group, the BMI dropped from 40.4 to 28.4 kg/m2 (p < 0.0001) and the AHI decreased from 75.1 to 4.5 event/h (p = 0.0004). The classic success rate for OSA was 90% and the cure rate was 60% in the CABS group. A perioperative assessment of CABS group patients also revealed a significant improvement in the Epworth sleepiness scale, minimal O2 saturation, snoring index and heart rate. CABS is feasible and safe in treating OSA with morbid obesity. CABS achieves more reduction in AHI than BS alone with high success and cure rates for OSA. CABS can also significantly improve quality of life and general health and offers a comprehensive alternative for morbidly obese OSA patients.

Successful use of remimazolam combined with remifentanil for painless gastroscopy in a patient with morbid obesity: a case report

“…Patients with morbid obesity have different degrees of abnormal fat distribution and accumulation in tissues throughout the body, which results in a large amount of soft-tissue hyperplasia in the oropharynx, muscle relaxation, sagging, and hyperplasia of the tongue, leading to a relative reduction in the volume of the oropharyngeal cavity and a relative reduction in the upper part of the tongue, leading to a decrease in the volume of the oropharyngeal cavity and a narrower upper airway. As a result, patients with morbid obesity tend to have comorbid obstructive sleep apnea syndrome and a high risk of difficult airway ( 4 ). Excessive thoracic and abdominal fat leads to thoracic and lumbar lordosis, limiting intercostal muscle movement and thoracic expansion.…”

Upper Airway Surgery or Weight Control? Modified Drug‐Induced Sleep Endoscopy for Obstructive Sleep Apnea

“…Therefore, anatomic obstruction‐oriented upper airway surgery should also be considered in OSA patients with obesity 32 . Lin et al revealed that combined airway surgery and bariatric surgery achieve 90% success rate 33 . Therefore, we can use these DISE modification findings to adjust our future surgery and treatment protocol.…”

“…32 Lin et al revealed that combined airway surgery and bariatric surgery achieve 90% success rate. 33 Therefore, we can use these DISE modification findings to adjust our future surgery and treatment protocol. That is, the integration of various conservative treatments, such as OA, positional therapy, intermittent negative airway pressure, weight control, and several kinds of surgical treatments, may effectively treat OSA, especially CCC.…”