Effect of Laparoscopic Roux-en-Y Gastric Bypass Surgery on Obstructive Sleep Apnea in a Chinese Population with Obesity and T2DM

Abstract

BackgroundBariatric surgery has been reported to be an effective treatment for obstructive sleep apnea (OSA). However, this evidence was not enough for different populations. Thus, we conducted a follow-up study to evaluate the effect of bariatric surgery on OSA in a Chinese population with obesity and type 2 diabetes mellitus (T2DM).MethodsFrom May 2011 to March 2014, 72 consecutive subjects with obesity and T2DM were recruited for this study. Before and at least 6 months after the laparoscopic Roux-en-Y gastric bypass (LYGB) surgery, all subjects were asked to undergo a polysomnography test. During the sleep center visit, anthropometric characteristic data, blood samples, and sleep questionnaires were collected.ResultsIn total, 44 Chinese participants with OSA were included in the study. Compared with baseline data, the postoperative anthropometric characteristics, blood measurements, and sleep recording data, such as weight, apnea hypopnea index (AHI), and insulin resistance index, differed significantly (p < 0.001). The change in AHI was correlated significantly with preoperative weight (r = 0.298, p < 0.05), preoperative AHI (r = 0.729, p < 0.001), preoperative waist circumference (r = 0.307, p < 0.05), and preoperative insulin resistance (IR) index (r = −0.301, p < 0.05). Postoperative AHI was correlated significantly with age (r = 0.039, p = 0.039) and preoperative AHI (r = 0.445, p = 0.002), and the following prediction model was generated: log10 (postoperative AHI) = 0.626 × log10 (preoperative AHI) +0.010 × age −0.581.ConclusionsOur findings indicate that LYGB could be an effective therapeutic intervention in the management of OSA for patients with both obesity and T2DM, and the preoperative AHI and age might be important factors that influence the effort of LYGB.Electronic supplementary materialThe online version of this article (doi:10.1007/s11695-014-1510-9) contains supplementary material, which is available to authorized users.

Decreased serum betatrophin may correlate with the improvement of obstructive sleep apnea after Roux-en-Y Gastric Bypass surgery

“…Weight reduction has been demonstrated as an important treatment for OSA, because even a small decrease in BMI can significantly improve the AHI 24 . However, the extent of weight loss did not correlate with OSA improvement 25 , which has also been found in our previous study 26 . Some authors have attributed this to the interaction of anatomic factors 27 and weight-independent metabolic effects 28 , such as the cytokines, gut hormones and adipokines.…”

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

“…As described below, there exists strong evidence to support bariatric procedures in the prevention and/or treatment of several ORCs. Specifically, interventional cohort studies and randomized clinical trials (RCTs) have demonstrated clinical benefits in patients with BMI ≥ 35 kg/m 2 and the following complications: T2D , high risk for T2D (prediabetes and/or MetS) , poorly controlled HTN , NAFLD/NASH , OSA , OA of the knee or hip , and improving outcomes of knee or hip replacement and urinary stress incontinence .…”

“…Weight loss of ~10% or more can improve OSA as assessed by polysomnography and the apnea‐hypopnea index (AHI) . Multiple trials assessing the efficacy of bariatric surgery have demonstrated efficacy for improvements in symptomatology and AHI scores in patients with OSA . For example, bariatric surgery resulting in 27 to 47% weight loss produced a 49 to 98% reduction in the AHI .…”

The impact of bariatric surgery on the resolution of obstructive sleep apnoea

“…Our study shows significant improvements in OSA after bariatric surgery, with 55.3% of patients demonstrating significant improvement or resolution using objective criteria. While this is a lower rate of resolution than in some of the published literature [ 12 , 21 , 22 ], it is based on objective measurements obtained from serial measurements during sleep clinic review rather than patient-reported symptoms as in much of the reported literature [ 12 ]. Although average pre-operative AHI readings whilst on CPAP were already below 10 events per hour (due to effective CPAP therapy), there were statistically significant decreases in AHI post-operatively.…”