Obstructive Sleep Apnea–Hypopnea Syndrome—The Role of Bariatric and Maxillofacial Surgeries

Abstract

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a complex disease with multifactorial etiology. It is marked by the occurrence of apnea and hypopnea events caused by repeated obstructions of the upper airways. OSAHS is strongly associated with obesity, and the prevalence of this disease in morbidly obese patients is very high. Nevertheless, not all patients with OSAHS are obese, and for this reason, there may be other anatomical predispositions to airway collapse. In obese patients, fatty deposition in the parapharyngeal region results in airway reduction and predisposes to airway collapse, worsened by neurologic loss of the normal dilator muscle tone of the neck. However, in nonobese patients, specific craniofacial characteristics such as posterior air pharyngeal space, tongue length, hyoid position, and maxillomandibular deficiencies may predispose some people to develop OSAHS. Treatment strategies for OSAHS patients vary from clinical treatment with continuous positive airway pressure, oral appliances, or medications for mild and moderate OSAHS patients, bariatric surgery for severe obese OSAHS patients to maxillomandibular advancement for obese or nonobese OSAHS patients.

Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery

“…Patients with OSA have been shown to have increased preoperative risk and specific perioperative measures have to been taken [4, 23]. …”

“…The exact pathophysiology of OSA in obese patients remains poorly understood, but it is thought that in obese patients the local fatty tissue deposition in the neck results in reduction of the lumen of the upper airway, thereby reducing airflow and inducing airway collapse [4]. …”

Dentofacial characteristics as indicator of obstructive sleep apnoea‐hypopnoea syndrome in patients with severe obesity

“…In the present study, only patients with severe obesity were analysed, as obesity has been found to be a contributing factor to the occurrence and severity of OSAHS (5–9). However, according to Fogel et al.…”

“…The pathogenesis of OSAHS is complex and not yet fully understood. Obesity has been confirmed to play an important role because of fatty deposition around the pharyngeal walls, which contributes towards the narrowing and collapsibility of the airway (5–8). However, not all patients with OSAHS are obese and therefore different features that cause nocturnal upper airway obstruction in obese and non‐obese patients are expected (18).…”

“…The role of obesity in the pathogenesis of OSAHS has been well established (4–9). However, not all patients with OSAHS are obese and may have another anatomic predisposition to airway collapse.…”