Therapeutic effect of laparoscopic sleeve gastrectomy on obstructive sleep apnea and relationship of type 2 diabetes in Japanese patients with severe obesity

Abstract

Aims/Introduction Obstructive sleep apnea (OSA) is among the most important obesity‐related diseases, and offers the potential for accelerated the early onset and progression of type 2 diabetes. The aim of the present study was to clarify the therapeutic effect of laparoscopic sleeve gastrectomy on OSA in severely obese Japanese patients, and to find correlations between OSA improvements and β‐cell function (BCF). Materials and Methods Between September 2013 and December 2019, 61 patients who underwent laparoscopic sleeve gastrectomy were enrolled. The apnea–hypopnea index (AHI) was used to diagnose OSA. The tongue area, uvula area and other parameters were measured using cone‐beam computed tomography. Regarding BCF parameters, the homeostasis model assessment of β‐cell function, insulinogenic, Matsuda and disposition indexes were used to evaluate the improvement in BCF. Improvement of OSA was defined as AHI <15. Results The improvement rate of OSA was 51.8% (29/56). The change in AHI was significantly correlated with the excess weight loss percentage (ρ = 0.501), changes in tongue area (ρ = 0.350) and uvula area (ρ = 0.341). Multivariate analysis showed that preoperative AHI and postoperative hemoglobin A1c were independent prognostic factors of OSA non‐improvement. The homeostasis model assessment of β‐cell function (P < 0.001), the insulinogenic index (P < 0.001) and the disposition index (P = 0.019) of patients with AHI of <15 were significantly higher than those in patients with AHI of ≥15. Conclusions Laparoscopic sleeve gastrectomy is a promising procedure for severely obese patients with OSA. BCF recovery was found to be significantly higher in patients with OSA improvement.

Factors Associated with Persistent Obstructive Sleep Apnea After Bariatric Surgery: A Narrative Review

“…The six studies are summarized in Table 1 . Yanari et al 17 and Morong et al 26 were retrospective studies. The other four studies, de Raaff et al, 27 Peromaa-Havisto et al, 20 Haines et al, 28 and Ravesloot et al, 29 were prospective studies.…”

“…Surgical procedures were Roux-en-Y gastric bypass (RYGB) for de Raaff et al, 27 Peromaa-Havisto et al, 20 and Haines et al, 28 sleeve gastrectomy (SG) for Yanari et al, 17 and Ravesloot et al 29 compared laparoscopic gastric banding (LAGB) vs RYGB vs SG. In one study, the applied surgery was not reported (Morong et al 26 ).…”

“…Six-to-nine month post-surgery reassessment was available in 2 studies (de Raaff et al 27 and Morong et al 26 ). Post-operative reevaluation was at 6 months and one year in 2 studies (Yanari et al 17 and Ravesloot et al 29 ). Changes at 11 to 12 months were assessed in 2 studies (Peromaa-Havisto et al 20 and Haines et al 28 ).…”

“…In Ravesloot et al, 29 age was not a predictive factor of OSA remission, unlike the results from de Raaff et al 27 in which older age predicted OSA persistence. Regarding comorbidities, Yanari et al 17 found that high glycated hemoglobin (HbA1c) post-surgery was an independent prognostic factor for OSA persistence. HT was also identified as a predictive factor of OSA persistence by de Raaff et al 27 …”

“…30 As obesity is the strongest risk factor for OSA, among the bariatric population, OSA prevalence reaches 45%–70%. 16 , 17 , 21 …”