Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea

Dixon, John; Schachter, Linda M.; O'Brien, Paul Edmond; Jones, Kay Margaret; Grima, Mariee; Lambert, Gavin W.; Brown, Wendy A.; Bailey, Michael; Naughton, Matthew T.

doi:10.1001/2012.jama.11580

Cited by 257 publications

(105 citation statements)

References 33 publications

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“…While observational studies suggest OSA severity improves by up to 76%, (17) a recent randomized trial found no significant difference between bariatric surgery and intensive medical weight loss as ancillary therapy for OSA. (18) However, gastric banding was the only surgical procedure offered in that trial suggesting greater benefits may have been achieved with more aggressive surgical procedures. Further studies are clearly needed to better define the role of bariatric surgery in the management of OSA.…”

Section: Discussionmentioning

confidence: 99%

Interest in bariatric surgery among obese patients with obstructive sleep apnea

Dudley

Tavakkoli

Andrews

et al. 2015

Surgery for Obesity and Related Diseases

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Background Standard obstructive sleep apnea (OSA) therapies are poorly tolerated. Bariatric surgery is a potential alternative but the level of interest in this intervention among OSA patients is unknown. Objectives Determine the proportion of OSA patients who would be interested in bariatric surgery. Setting Sleep clinics, United States. Methods Consecutive adult patients with untreated severe OSA and a body mass index of 35–45 kg/m2 were approached. Patients at low peri-operative risk and no urgent indication for OSA treatment were invited to a separate informational visit about bariatric surgery as primary treatment for OSA. Results Of 767 eligible patients, 230 (30.0%) were not at low peri-operative risk, 49 (6.4%) had drowsy driving, and 16 (2.1%) had no insurance coverage for bariatric surgery. Of the remaining 482 patients, over one-third (35.5%) were interested in bariatric surgery. Surgical interest was 47.2% in women vs. 27.6% in men (p <0.01) and 67.3% in diabetics vs. 31.0% in non-diabetics (p<0.01). In multivariable adjusted models, female gender (odds ratio 1.89, 95% CI [1.10–3.25]) and diabetes (odds ratio 3.97, 95% CI [1.97–8.01]) remained highly predictive of bariatric surgery interest. Conclusions Nearly two-thirds of obese patients with severe OSA are good candidates for bariatric surgery. Among candidates, over one-third are interested in this treatment. Interest rates are highest among women and diabetics, indicating that metabolic improvements continue to be a major driver of surgery even in patients with severe OSA. Given patient interest, the role of bariatric surgery should be routinely discussed with obese OSA patients.

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Section: Discussionmentioning

confidence: 99%

Interest in bariatric surgery among obese patients with obstructive sleep apnea

Dudley

Tavakkoli

Andrews

et al. 2015

Surgery for Obesity and Related Diseases

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“…Bariatric surgery for individuals considered severely obese is reported to be associated with reductions in comorbidities, obesity-related complications and all-cause mortality [24]. Comparing surgical and conventional weight loss therapy for the management of OSA, Dixon et al [25] demonstrated greater weight loss in the surgically treated group [25]. …”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial

Aguiar

Freitas

Santos

et al. 2014

Multidiscip Respir Med

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BackgroundThe increasing prevalence of obesity in both developed and developing countries is one of the most serious public health problems and has led to a global epidemic. Obesity is one of the greatest risk factors of obstructive sleep apnea (OSA), which is found in 60 to 70% of obese patients mainly due to the buildup of fat tissue in the upper portion of the thorax and neck. The aim of the present randomized clinical trial is to assess daytime sleepiness, sleep architecture and pulmonary function in patients with severe obesity before and after bariatric surgery.MethodsThis randomized, controlled trial, was designed, conducted, and reported in accordance with the standards of The CONSORT (Consolidated Standards of Reporting Trials) Statement. Patients were divided into a bariatric surgery group and control group. The clinical evaluation was performed at the Sleep Laboratory of the Nove de JulhoUniversity (Sao Paulo, Brazil) and consisted of the collection of clinical data, weight, height, body mass index (BMI), measurements of neck and abdomen circumferences, spirometry, maximum ventilatory pressure measurements, standard overnight polysomnography (PSG) and the administration of the Berlin Questionnaire and Epworth Sleepiness Scale.ResultsFifty-two patients participated in the present study and performed PSG. Out of these, 16 underwent bariatric surgery. After surgery, mean BMI decreased from 48.15 ± 8.58 to 36.91 ± 6.67 Kg/m2. Significant differences were found between the preoperative and postoperative periods regarding neck (p < 0.001) and waist circumference (p < 0.001), maximum inspiratory pressure (p = 0.002 and p = 0.004) and maximum expiratory pressure (p = 0.001 and p = 0.002) for women and men, respectively, as well as sleep stage N3 (p < 0.001), REM sleep (p = 0.049) and the apnea-hypopnea index (p = 0.008).ConclusionsBariatric surgery effectively reduces neck and waist circumference, increases maximum ventilatory pressures, enhances sleep architecture and reduces respiratory sleep disorders, specifically obstructive sleep apnea, in patients with severe obesity.Trial registrationThe protocol for this study was registered with the World Health Organization (Universal Trial Number: U1111-1121-8873) and Brazilian Registry of Clinical Trials – ReBEC (RBR-9k9hhv).

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“…71 Nevertheless, the substantial decrease in weight in both treatment arms translated to an improvement in OSA severity (decrease in AHI by 26 for surgically treated patients versus decrease by 14 for those in the regular weight loss arm), suggesting that life style modification aimed at weight loss and increased activity should play a prominent role in managing OSA patients.…”

Section: Alternatives and Supplements To Cpap Therapy In Osamentioning

confidence: 98%