Effect of Surgical Weight Loss on Sleep Architecture in Adolescents with Severe Obesity

Kalra, Maninder; Mannaa, Mohannad; Fitz, Kelly; Sricharan, Kumar; Chakraborty, Ranajit; Sheng, Xinjun; Inge, Thomas H.

doi:10.1007/s11695-008-9472-4

Cited by 30 publications

(28 citation statements)

References 31 publications

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“…[47][48][49] Conversely, interventions aiming to reduce the degree of adiposity have also been associated with improvements in OSA. 50,51 In summary, the present study conclusively demonstrates that for any level of OSA severity the habitually snoring obese child requires less adenotonsillar hypertrophy when compared to nonobese children of the same age, gender, and ethnicity. These differences appear to be mediated, at least in part, by the presence of a more crowded airway in obese children, as a corollary to increased fat deposits in the airway.…”

Section: Discussionsupporting

confidence: 65%

Obstructive Sleep Apnea in Children

Dayyat

Kheirandish‐Gozal

Capdevila

et al. 2009

Chest

202

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Section: Discussionsupporting

confidence: 65%

Obstructive Sleep Apnea in Children

Dayyat

Kheirandish‐Gozal

Capdevila

et al. 2009

Chest

202

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“…16 In addition to consistently lowering AHI, weight loss following surgery has been reported to improve nocturnal sleep architecture. [13][14][15] This includes decreasing stage 1 sleep, and increasing the expression of stage 2 sleep, REM sleep, and SWS. [13][14][15] Since in each case, body weight and AHI were concomitantly reduced after surgery, it is unclear which is driving these favorable changes in sleep: the weight loss or the improved AHI.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] This includes decreasing stage 1 sleep, and increasing the expression of stage 2 sleep, REM sleep, and SWS. [13][14][15] Since in each case, body weight and AHI were concomitantly reduced after surgery, it is unclear which is driving these favorable changes in sleep: the weight loss or the improved AHI. Current results indicate that the improvements in stage 1, stage 2, and REM sleep, are more likely to be influenced by the reduction in OSA severity than by the loss of body weight per se.…”

Section: Discussionmentioning

confidence: 99%

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Sleep Architecture Following a Weight Loss Intervention in Overweight and Obese Patients with Obstructive Sleep Apnea and Type 2 Diabetes: Relationship to Apnea-Hypopnea Index

Shechter

St‐Onge

Kuna

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: To determine if weight loss and/or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA). Methods: This was a randomized controlled trial including 264 overweight/obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups. Results: Changes in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a signifi cant positive association between AHI and stage 1 sleep (p < 0.001), and a signifi cant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a signifi cant positive association with change in body weight (p = 0.009). Conclusions: Compared to control, the ILI did not induce signifi cant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more infl uenced by weight than AHI. S C I E N T I F I C I N V E S T I G A T I O N SO besity, type 2 diabetes (T2D), and obstructive sleep apnea (OSA) are three related disorders which have been demonstrated to co-occur in patients. Indeed, obesity is established as one of the leading risk factors for the development of both T2D and OSA, and a high prevalence (~86.6%) of undiagnosed OSA was found in obese patients with T2D.1 Defi cits in sleep duration and/or quality may be a common link among these three factors. A growing body of both epidemiological and laboratory-based studies supports a role of short sleep duration in the development of obesity.2-4 Sleep curtailment is also associated with increased incidence of T2D as well as defi cits in glucose regulation. BRIEF SUMMARYCurrent Knowledge/Study Rationale: A growing body of evidence supports a relationship between sleep and obesity. A long-term weight loss intervention (up to 4 years) has previously been shown to improve the severity of sleep disordered breathing in a group of overweight and obese patients with obstructive sleep apnea (OSA) and type 2 diabetes, although the effects of the structured weight loss program on nocturnal sleep duration and architecture have not yet been explored. Study Impact: Although the weight loss intervention was effective in reducing the severity of OSA over a 4-year period, it did not lead to changes in the various po...

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“…Although definitive studies are underway, many have shown that surgery in adolescents results in improvement or resolution of numerous comorbid conditions including sleep apnea, 312 diabetes 313 and improvement in quality of life. 314,315 Perioperative and longer term risks must be acknowledged, 309,316 and bariatric surgery among severely obese adolescents is a viable option, 317,318 but further research is required to determine the long-term effectiveness of this approach.…”

Section: Bariatric Surgery For Obesity and Risk Factor Reduction In Pmentioning

confidence: 99%

An evolving scientific basis for the prevention and treatment of pediatric obesity

et al. 2014

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The 2013 Pennington Biomedical Research Center’s Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world.

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Effect of Surgical Weight Loss on Sleep Architecture in Adolescents with Severe Obesity

Cited by 30 publications

References 31 publications

Obstructive Sleep Apnea in Children

Obstructive Sleep Apnea in Children

Sleep Architecture Following a Weight Loss Intervention in Overweight and Obese Patients with Obstructive Sleep Apnea and Type 2 Diabetes: Relationship to Apnea-Hypopnea Index

An evolving scientific basis for the prevention and treatment of pediatric obesity

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