Prevalence of Sleep Apnea in Morbidly Obese Patients who Presented for Weight Loss Surgery Evaluation: More Evidence for Routine Screening for Obstructive Sleep Apnea before Weight Loss Surgery

Abstract

The incidence of obstructive sleep apnea has been underestimated in morbidly obese patients who present for evaluation for weight loss surgery. This retrospective study shows that the incidence of obstructive sleep apnea in this patient population is greater than 70 per cent and increases in incidence as the body mass index increases. Obstructive sleep apnea (OSA) is a common comorbidity in obese patients who present for evaluation for gastric bypass surgery. The incidence of sleep apnea in obese patients has been reported to be as high as 40 per cent. A retrospective review of our prospectively collected database was performed. All patients being evaluated for weight loss surgery for obesity were screened preoperatively for OSA using a sleep study. The overall incidence of sleep apnea in our patients was 78 per cent (227 of 290). All 227 were diagnosed by formal sleep study. There were 63 (22%) males and 227 (78%) females. The mean age was 43 years (range, 17–75 years). The mean body mass index (BMI) was 52 kg/m2 (range, 31–94 kg/m2). The prevalence of OSA in the severely obese group (BMI 35–39.9 kg/m2) was 71 per cent. For the morbidly obese group (BMI 40–40.9 kg/m2), the prevalence was 74 per cent and for the superobese group (BMI 50–59.9 kg/m2) 77 per cent. Those with a BMI 60 kg/m2 or greater, the prevalence of OSA rose to 95 per cent. The incidence of sleep apnea in patients presenting for weight loss surgery was greater than 70 per cent in our study. Patients presenting for weight loss surgery should undergo a formal sleep study to diagnose OSA before bariatric surgery.

Battle of the super obese sexes: female versus male variation in pre-operative clinical characteristics among 1,673 surgical patients undergoing bilio-pancreatic bypass/duodenal switch (BPD/DS)

“…Obesity and increased BMI contribute to this higher risk as it potentiates the development of OSA. 13 Increased BMI and increased OSA among obese BPD/DS men over women in the current investigation validates previous reports.…”

Snoring and Risk of Obstructive Sleep Apnoea in Malaysian Pregnant Women

“…Our data showed, more than 50% of them with BMI of 35-39.9 kg/m 2 are snoring, and 33.3% of women in this group have significant high risk of OSA (p -value of 0.00) and these finding correlates with a few other studies [28,29]. In fact, one of the studies has quoted that a higher percentage of 71% of pregnant women with severe obesity has OSA [29]. The phenomenon could be explained by the possibility of increased likelihood of pharyngeal airway collapse by fat deposition around the lateral walls of pharyngeal airway in the muscles.…”

“…In our study, we had compared pregnant women who snore and non-snorers with BMI according to the Malaysian Clinical Practice Guidelines. Our data showed, more than 50% of them with BMI of 35-39.9 kg/m 2 are snoring, and 33.3% of women in this group have significant high risk of OSA (p -value of 0.00) and these finding correlates with a few other studies [28,29]. In fact, one of the studies has quoted that a higher percentage of 71% of pregnant women with severe obesity has OSA [29].…”

Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity

“…In some severely obese patients improvements in Rrs with weight loss might occur with resolution of upper airway obstruction associated with obstructive sleep apnea (Schwartz et al 1991). Since the prevalence of obstructive sleep apnea in severely obese patients presenting for weight loss surgery is about 74 % (Lopez et al 2008), it is quite likely that some of our study participants may have had D r a f t undiagnosed sleep apnea that could possibly have improved with weight loss resulting in improved sleep quality (Table 6).…”