The Role of Bariatric Surgery in Obstructive Sleep Apnea Syndrome

Abstract

OBJECTIVES:Obesity is a chronic disease that impacts all age groups worldwide and leads to serious health problems, such as obstructive sleep apnea syndrome (OSAS). Bariatric surgery is a treatment option for patients with both OSAS and obesity who fail to lose weight. The efficacy of bariatric surgery in morbidly obese patients with OSAS was evaluated. MATERIAL AND METHODS:Twenty-six patients for whom obesity surgery was planned were enrolled. All subjects underwent overnight polysomnography (PSG) preoperatively and postoperatively within 8.35 (±2.31) months. OSAS symptoms and sleep parameters were evaluated. RESULTS:Symptoms were evaluated preoperatively and postoperatively in patients with (17, 65.4%) and without (9, 34.6%) OSAS. PSG results and sleep parameters were evaluated preoperatively and postoperatively in patients with OSAS (17/26) and those who completed the follow-up. All sleep parameter values for respiratory disturbance index (RDI), rapid eye movement (REM) RDI, non-REM RDI, apnea index (AI), and 3% oxyhemoglobin desaturation index were improved significantly (p<0.05). CONCLUSION:Bariatric surgery may be another treatment option for morbidly obese patients with OSAS that is to be used together with other treatments, such as non-invasive mechanical ventilation. KEY WORDS:Sleep apnea syndrome, bariatric surgery, morbid obesity INTRODUCTIONObesity is a chronic disease with an impact on all age groups and an increasing incidence. The World Health Organization defines obesity as having a body mass index (BMI) >30 kg/m 2 , and according to 2008 data, >500 million adults are obese worldwide [1]. A BMI ≥40 kg/m 2 defined as morbid obesity.Obesity may lead to serious health problems. The association between obesity and obstructive sleep apnea syndrome (OSAS) is well known. Although OSAS affects 2%-4% of the adult population, the prevalence increases to 40%-70% in obese patients. This risk increases tremendously in morbidly obese cases [2,3].Recurrent collapse of the upper airway results in OSAS signs and symptoms (sleep fragmentation, excessive daytime sleepiness (EDS), witnessed apnea) [3]. As BMI increases, the surrounding excess fat tissue increases airway collapsibility, and OSAS symptoms become more evident.Non-invasive mechanical ventilation (NIMV), oral appliances, and upper respiratory tract surgery are treatment options for OSAS to maintain the airway open. In addition to these modalities, bariatric surgery is another effective treatment option (gastric band, tube, sleeve gastrectomy, gastric by-pass, and gastric balloon) in obese patients with a BMI >40 kg/m 2 whose diet program is unsuccessful or those with a BMI >35 kg/m 2 with co-morbid diseases. Gastric surgery may lead to significant weight loss and eventual improvement in OSAS severity or decrease NIMV pressure.Gastric by-pass and sleeve gastrectomy are the most frequently used methods. The overall mortality rate is <1%, and that of morbidity is 5% [2,[4][5][6].The primary objective of the study was to evaluate the effect of bariatric surg...