Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea

Haines, Krista; Nelson, Louisa; González, Ricardo Rodríguez; Torrella, Tracy; Martin, Taylor; Kandil, Ali; Dragotti, Robert; Anderson, William M.; Gallagher, Scott F.; Murr, Michel M.

doi:10.1016/j.surg.2006.08.012

Cited by 153 publications

(112 citation statements)

References 17 publications

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“…The most dramatic results have been reported with surgical weight loss. [312][313][314] In addition, apnea often is worse in the supine posture, with some patients having OSA only in that position. 315,316 For patients with "positional apnea," behavioral techniques aimed at keeping the patient in the lateral posture during sleep (an uncomfortable object sewn into the back of the nightshirt or positional alarms) may offer benefit.…”

Section: Treatment Options In Osamentioning

confidence: 99%

Sleep Apnea and Cardiovascular Disease

et al. 2008

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Section: Treatment Options In Osamentioning

confidence: 99%

Sleep Apnea and Cardiovascular Disease

et al. 2008

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“…In recent years, bariatric surgical procedures have been increasingly used for the treatment of severe obesity. These procedures combine gastric restriction and/or intestinal bypass to induce early satiety and nutrient malabsorbtion, respectively (35,(169)(170)(171)(172), and lead to an approximately 60% loss in excess body weight in the first 12 to 18 months postoperatively (173)(174)(175)(176)(177)(178)(179)(180)(181)(182)(183)(184)(185). In a recent meta-analysis of bariatric studies involving 22,094 patients, Buchwald and colleagues (11) Improvements in sleep apnea with weight loss have been related to effects of adiposity on upper airway function during sleep.…”

Section: Weight Loss Sleep Apnea and Upper Airway Functionmentioning

confidence: 99%

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

Schwartz

Patil²,

Laffan

et al. 2008

Proceedings of the American Thoracic Society

583

395

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Obstructive sleep apnea is a common disorder whose prevalence is linked to an epidemic of obesity in Western society. Sleep apnea is due to recurrent episodes of upper airway obstruction during sleep that are caused by elevations in upper airway collapsibility during sleep. Collapsibility can be increased by underlying anatomic alterations and/or disturbances in upper airway neuromuscular control, both of which play key roles in the pathogenesis of obstructive sleep apnea. Obesity and particularly central adiposity are potent risk factors for sleep apnea. They can increase pharyngeal collapsibility through mechanical effects on pharyngeal soft tissues and lung volume, and through central nervous system-acting signaling proteins (adipokines) that may affect airway neuromuscular control. Specific molecular signaling pathways encode differences in the distribution and metabolic activity of adipose tissue. These differences can produce alterations in the mechanical and neural control of upper airway collapsibility, which determine sleep apnea susceptibility. Although weight loss reduces upper airway collapsibility during sleep, it is not known whether its effects are mediated primarily by improvement in upper airway mechanical properties or neuromuscular control. A variety of behavioral, pharmacologic, and surgical approaches to weight loss may be of benefit to patients with sleep apnea, through distinct effects on the mass and activity of regional adipose stores. Examining responses to specific weight loss strategies will provide critical insight into mechanisms linking obesity and sleep apnea, and will help to elucidate the humoral and molecular predictors of weight loss responses.

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“…Only 3 of our patients had ESS scores >12. ESS may not highlight OSAS; however, a full overnight PSG was suggested for all morbidly obese patients before surgery [12,13].…”

Section: Discussionmentioning

confidence: 99%

The Role of Bariatric Surgery in Obstructive Sleep Apnea Syndrome

Karaköse¹,

Bozkurt²,

Akkoyunlu³

et al. 2014

Tur Toraks Der

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OBJECTIVES:Obesity is a chronic disease that impacts all age groups worldwide and leads to serious health problems, such as obstructive sleep apnea syndrome (OSAS). Bariatric surgery is a treatment option for patients with both OSAS and obesity who fail to lose weight. The efficacy of bariatric surgery in morbidly obese patients with OSAS was evaluated. MATERIAL AND METHODS:Twenty-six patients for whom obesity surgery was planned were enrolled. All subjects underwent overnight polysomnography (PSG) preoperatively and postoperatively within 8.35 (±2.31) months. OSAS symptoms and sleep parameters were evaluated. RESULTS:Symptoms were evaluated preoperatively and postoperatively in patients with (17, 65.4%) and without (9, 34.6%) OSAS. PSG results and sleep parameters were evaluated preoperatively and postoperatively in patients with OSAS (17/26) and those who completed the follow-up. All sleep parameter values for respiratory disturbance index (RDI), rapid eye movement (REM) RDI, non-REM RDI, apnea index (AI), and 3% oxyhemoglobin desaturation index were improved significantly (p<0.05). CONCLUSION:Bariatric surgery may be another treatment option for morbidly obese patients with OSAS that is to be used together with other treatments, such as non-invasive mechanical ventilation. KEY WORDS:Sleep apnea syndrome, bariatric surgery, morbid obesity INTRODUCTIONObesity is a chronic disease with an impact on all age groups and an increasing incidence. The World Health Organization defines obesity as having a body mass index (BMI) >30 kg/m 2 , and according to 2008 data, >500 million adults are obese worldwide [1]. A BMI ≥40 kg/m 2 defined as morbid obesity.Obesity may lead to serious health problems. The association between obesity and obstructive sleep apnea syndrome (OSAS) is well known. Although OSAS affects 2%-4% of the adult population, the prevalence increases to 40%-70% in obese patients. This risk increases tremendously in morbidly obese cases [2,3].Recurrent collapse of the upper airway results in OSAS signs and symptoms (sleep fragmentation, excessive daytime sleepiness (EDS), witnessed apnea) [3]. As BMI increases, the surrounding excess fat tissue increases airway collapsibility, and OSAS symptoms become more evident.Non-invasive mechanical ventilation (NIMV), oral appliances, and upper respiratory tract surgery are treatment options for OSAS to maintain the airway open. In addition to these modalities, bariatric surgery is another effective treatment option (gastric band, tube, sleeve gastrectomy, gastric by-pass, and gastric balloon) in obese patients with a BMI >40 kg/m 2 whose diet program is unsuccessful or those with a BMI >35 kg/m 2 with co-morbid diseases. Gastric surgery may lead to significant weight loss and eventual improvement in OSAS severity or decrease NIMV pressure.Gastric by-pass and sleeve gastrectomy are the most frequently used methods. The overall mortality rate is <1%, and that of morbidity is 5% [2,[4][5][6].The primary objective of the study was to evaluate the effect of bariatric surg...

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Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea

Cited by 153 publications

References 17 publications

Sleep Apnea and Cardiovascular Disease

Sleep Apnea and Cardiovascular Disease

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

The Role of Bariatric Surgery in Obstructive Sleep Apnea Syndrome

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