Prevalence and Severity of Sleep Apnea in a Group of Morbidly Obese Patients

Daltro, Carla; Gregório, Paloma Baiardi; Alves, Erivaldo; Abreu, Maurício Costa de; Bomfim, Daniel Veloso Viana; Chicourel, Maria Helena; Araújo, Leila Maria Batista; Cotrim, Helma Pinchemel

doi:10.1007/s11695-007-9147-6

Cited by 68 publications

(54 citation statements)

References 24 publications

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“…17 Obstructive sleep apnea (OSA) is another common breathing disorder among the obese that, in addition to obesity-hypoventilation syndrome, must be taken into account before surgery. 18,19 …”

Section: Physiological Characteristics Of the Respiratory System Durimentioning

confidence: 99%

Respiratory Management of Perioperative Obese Patients

et al. 2016

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SummaryWith a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia.

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Section: Physiological Characteristics Of the Respiratory System Durimentioning

confidence: 99%

Respiratory Management of Perioperative Obese Patients

et al. 2016

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“…Obesity is associated with many different comorbidities including obstructive sleep apnoea (OSA). [2][3][4][5] Worldwide, studies have found a high level of clinically undiagnosed OSA in obese patients, particularly those who are morbidly obese. 3,4,6 However, no studies have sought to establish the size of this association in clinical practice in the UK.…”

Section: Introductionmentioning

confidence: 99%

Body mass index and obstructive sleep apnoea in the UK: a cross-sectional study of the over-50s

Wall¹,

Smith

Hubbard

2012

Primary Care Respiratory Journal

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“…7 This relationship is well documented in the literature. 8 However, there has been no previous study to quantify this association within the general population in the UK.…”

Section: -5mentioning

confidence: 99%

“…7 This relationship is well documented in the literature. 8 However, there has been no previous study to quantify this association within the general population in the UK.The study by Wall and colleagues 9 in this issue of the PCRJ is the first time the strength of association between OSA, snoring and obesity has been investigated in the UK using a large primary care database. In a cross-sectional study of records from The Health Improvement Network (THIN) database, and controlling for confounding factors such as gender, age, region, and socioeconomic status, they used logistic regression techniques to explore the relationship between body mass index (BMI), a history of snoring, and a diagnosis of OSA in the over-50s in the UK.…”

mentioning

confidence: 99%

Obstructive sleep apnoea: quantifying its association with obesity and snoring

Parekh

Green

Majeed

2012

Primary Care Respiratory Journal

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Obstructive sleep apnoea (OSA) is a chronic condition with an estimated prevalence of between 2-3% in the UK, although a large proportion of individuals with OSA remain undiagnosed. 1,2 It is caused by repetitive pharyngeal collapse during sleep, which is restored with recurrent arousals and activation of the sympathetic nervous system. Interest around the condition has increased following evidence showing an association of OSA with hypertension, type 2 diabetes mellitus and coronary artery disease, together with adverse health outcomes. 3-5The burden of obesity remains one of the largest public health issues facing the UK. Studies suggest that 67% of men and 69% of women in England are obese or overweight.6 Such levels of obesity lead to wide ranging public health consequences, including significant medical, social, and financial burdens on individuals and society. Estimates suggest that the annual direct cost of obesity to the UK National Health Service (NHS) stands at £3.2 billion. 6 The relationship between OSA and obesity remains complex and multi-factorial; a recent review by Carter & Watenpaugh demonstrates the bidirectional causality between OSA and obesity, which can lead to a cycle of worsening symptoms of both conditions. 7 This relationship is well documented in the literature. 8 However, there has been no previous study to quantify this association within the general population in the UK.The study by Wall and colleagues 9 in this issue of the PCRJ is the first time the strength of association between OSA, snoring and obesity has been investigated in the UK using a large primary care database. In a cross-sectional study of records from The Health Improvement Network (THIN) database, and controlling for confounding factors such as gender, age, region, and socioeconomic status, they used logistic regression techniques to explore the relationship between body mass index (BMI), a history of snoring, and a diagnosis of OSA in the over-50s in the UK. They report that 88% of patients aged 50 and over had a recorded BMI, and that 55% of patients with a recorded BMI were overweight or obese, with the prevalence of OSA increasing progressively with increasing BMI. 96% of patients with a diagnosis of OSA had a recorded BMI. Perhaps the most important result from the study is that individuals with a BMI over 40 kg/m 2 were 27 times more likely to have a diagnosis of OSA when compared to those with a normal BMI. 27% of people with a diagnosis of OSA are recorded as being snorers, an equivalent multivariate analysis odds ratio for OSA in snorers of 26. Interestingly, the levels of OSA decreased with increasing age and deprivation after controlling for confounding factors.When comparing these results to those from other studies, the initial striking factor is the low prevalence of a diagnosis of OSA (0.6%) in those with a recorded BMI. 9 The reasons for this may include coding variability on primary care computer systems, under-diagnosis by clinicians, or people with OSA not presenting to primary healthcare service...

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Prevalence and Severity of Sleep Apnea in a Group of Morbidly Obese Patients

Abstract: There was a high frequency of sleep apnea in this group of morbidly obese patients, for whom it was very important to request polysomnography, thus enabling therapeutic management and prognostication.

Cited by 68 publications

References 24 publications

Respiratory Management of Perioperative Obese Patients

Respiratory Management of Perioperative Obese Patients

Body mass index and obstructive sleep apnoea in the UK: a cross-sectional study of the over-50s

Obstructive sleep apnoea: quantifying its association with obesity and snoring

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