Bariatric Surgery for Treatment of Sleep Apnea Syndrome in 15 Morbidly Obese Patients: Long‐Term Results

Scheuller, Michael C.; Weider, Dudley J.

doi:10.1067/mhn.2001.119139

Cited by 76 publications

(23 citation statements)

References 18 publications

(30 reference statements)

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“…Changes in PSG at follow-up are consistent with those described following more invasive bariatric surgery such as vertical banded gastroplasty, Roux-en-Y gastric bypass and biliopancreatic diversion. [19][20][21] However, in the past, daytime sleepiness, metabolic health and health-related QOL have not been measured simultaneously. This study demonstrates improvement in sleep architecture in addition to a reduction in AHI, in association with weight loss.…”

Section: Discussionmentioning

confidence: 99%

“…These studies have generally been small and often only followed a small proportion of patients, but have all shown polysomnographic evidence of significant improvement or resolution of OSA (Table 1). 17,[19][20][21][22] None of these studies has simultaneously examined a broader range of outcomes, which could include an assessment of daytime sleepiness, biochemical markers of the metabolic syndrome, and psychological and QOL measures. We hypothesize that in severely obese patients with OSA, significant weight loss would provide effective therapy for OSA, daytime sleepiness, impaired QOL and cardiovascular risk associated with the metabolic syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Polysomnography before and after weight loss in obese patients with severe sleep apnea

2005

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OBJECTIVE: While obstructive sleep apnea (OSA) is strongly related to obesity, few studies have examined polysomnographic (PSG) changes with major weight loss. We examined the effect of weight loss following laparoscopic adjustable gastric banding (LAGB) on the PSG changes in patients with severe OSA. In addition, we studied daytime sleepiness, the metabolic syndrome and quality of life (QOL). METHODS: A prospective study was conducted of 25 severely obese patients (17 men, eight women) with paired diagnostic PSG, biochemical and questionnaire studies, the first prior to LAGB and the second at least 1 y later. Subjects with a baseline apnea-hypopnea index (AHI) 425/h were included. RESULTS: Subject baseline age was 44.7 y, weight 154 kg and body mass index 52.7 kg/m 2 . The second PSG study was conducted 17.7710 (range 12-42) months after surgery and mean percentage of excess loss and weight loss were 50.1715% (range 24-80%) and 44.9722 kg (range 18-103 kg), respectively. There was a significant fall in AHI from 61.6734 to 13.4713, improved sleep architecture with increased REM and stage III and IV sleep, daytime sleepiness, as measured by Epworth Sleepiness Scale, of 1377.0 to 3.873.0, and fewer patients requiring nasal continuous positive airways pressure (CPAP). There were also major improvements in the metabolic syndrome, QOL, body image and fewer symptoms of depression (Po0.05 for all). CONCLUSION: Weight loss provides major improvement or resolution of OSA and CPAP requirements. It also reduces daytime sleepiness, and improves the metabolic syndrome and QOL. LAGB placement should be considered a broadly effective therapy for sleep apnea in the severely obese patient.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Polysomnography before and after weight loss in obese patients with severe sleep apnea

2005

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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

555

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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“…www.bjournal.com.br morbid obesity have shown a reduction in the AHI after losing weight (10,11). In some cases, however, there is no cure for the condition, suggesting that obesity may not be the only factor responsible for its physiopathology (12,13).…”

Section: Introductionmentioning

confidence: 99%

Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients

Martinho

Tangerina

Moura

et al. 2008

Braz J Med Biol Res

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Our aim was to determine if anatomical abnormalities of the upper airway (UA) and facial skeleton of class III severely obese patients are related to the presence and severity of obstructive sleep apnea syndrome (OSAS). Forty-five patients (69% females, mean age 46.5 ± 10.8 years) with a body mass index (BMI) over 40 kg/m 2 underwent UA and facial skeletal examinations as well as polysomnography. Mean BMI was 49 ± 7 kg/m 2 and mean neck circumference was 43.4 ± 5.1 cm. Polysomnographic findings showed that 22% had a normal apnea-hypopnea index (AHI) and 78% had an AHI over 5. The presence of OSAS was associated with younger age (P = 0.02), larger neck circumference (P = 0.004), presence of a voluminous lateral wall (P = 0.0002), posteriorized soft palate (P = 0.0053), thick soft palate (P = 0.0014), long uvula (P = 0.04), thick uvula (P = 0.0052), and inferior turbinate hypertrophy (P = 0.04). A larger neck circumference (P = 0.02), presence of a voluminous lateral wall (P = 0.04), posteriorized soft palate (P = 0.03), and thick soft palate (P = 0.04) were all associated with OSAS severity. The prevalence of OSAS in this group was high. A larger neck circumference and soft tissue abnormalities of the UA were markers for both the presence and severity of OSAS. Conversely, no abnormalities in the facial skeleton were associated with OSAS in patients with morbid obesity.

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Bariatric Surgery for Treatment of Sleep Apnea Syndrome in 15 Morbidly Obese Patients: Long‐Term Results

Cited by 76 publications

References 18 publications

Polysomnography before and after weight loss in obese patients with severe sleep apnea

Polysomnography before and after weight loss in obese patients with severe sleep apnea

Obesity and Obstructive Sleep Apnea: Pathogenic Mechanisms and Therapeutic Approaches

Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients

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