Clinical Predictors of Obstructive Sleep Apnea in Asian Bariatric Patients
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Obstructive sleep apnea (OSA) is a common disorder in modern society and closely associated with obesity. Because OSA increases the likelihood of complications in the perioperative period, preoperative recognition is very important for bariatric patients. Polysomnography (PSG) remains the gold standard for diagnosis, but it is a time-consuming and expensive examination. Our study is aimed at identifying practical clinical predictors of OSA for bariatric patients.
From April 2006 to December 2007, 101 morbid obese patients [41 men and 60 women, mean age 30.3 ± 8.5, mean body mass index (BMI) 43.3 ± 6.9] who underwent PSG before bariatric surgery were retrospectively studied. The severity of OSA was categorized by the apnea–hypopnea index (AHI) as follows: normal, 0 to 4.9; mild, 5 to 14.9; moderate, 15 to 29.9; and severe, ≥30. Chi-squared tests and linear regression models were used to assess associations between clinical parameters and AHI; P < 0.05 was considered statistically significant.
The mean Epworth sleepiness scale (ESS) score was 8.2 ± 4.7, and the mean AHI was 28.9 ± 33.8 per hour. Of 101 patients, 83 patients had OSA; including severe (32.7%), moderate (17.8%), and mild (31.7%) OSA; 18.5% had no OSA. Patients with severe OSA are significantly male predominant and had higher BMI, systolic blood pressure, hemoglobin, neck and waist circumference, and ESS scores. In linear regression model analysis, the parameters which positively correlated with AHI were body weight, BMI, systolic blood pressure, diastolic blood pressure, hemoglobin, waist and neck circumferences, and the scores of ESS. Multivariate analysis confirmed that BMI, neck circumference, and scores of ESS are independent predictors of the increasing of AHI.
OSA is highly prevalent (82.2%) in Asian bariatric patients. BMI, neck circumference, and scores of ESS are independent predictors of OSA in these patients.
- Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5. CrossRef
- Kyzer S, Charuzi I. Obstructive sleep apnea in the obese. World J Surg. 1998;22:998–1001. CrossRef
- Rasheid S, Banasiak M, Gallagher SF, et al. Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity. Obes Surg. 2003;13:58–61. CrossRef
- Serafini FM, Anderson MW, Rosemurgy AS, et al. Clinical predictors of sleep apnea in patients undergoing bariatric surgery. Obes Surg. 2001;11:28–31. CrossRef
- O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg. 2004;14:23–6. CrossRef
- McNicholas WT. Diagnosis of obstructive sleep apnea in adults. Proc Am Thorac Soc. 2008;5:154–60. CrossRef
- Haines KL, Nelson LG, Gonzalez R, et al. Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surg. 2007;141:354–8. CrossRef
- Dixon JB, Schachter LM, O’Brien PE. Predicting sleep apnea and excessive daytime sleepiness in the severely obese: indicators for polysomnography. Chest. 2003;123:1134–41. CrossRef
- Lee WJ, Huang MT, Wang W, et al. Effects of obesity surgery on the metabolic syndrome. Arch Surg. 2004;139:1088–92. CrossRef
- Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective. Obes Surg. 2005;15:751–7. CrossRef
- Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14:540–5.
- Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15:376–81.
- Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor of hypertension. Arch Intern Med. 1997;157:1746–52. CrossRef
- Lee WJ, Yu PY, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8. CrossRef
- Lee WJ, Wang W, Yu PJ, et al. Gastrointestinal quality of life following laparoscopic adjustable gastric banding in Asia. Obes Surg. 2006;16:586–91. CrossRef
- Chiu CC, Lee WJ, Wang W, et al. Prevention of trocar-wound hernia in laparoscopic bariatric operations. Obes Surg. 2006;16:913–8. CrossRef
- Cote C, Zilberberg MD, Mody SH, et al. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J. 2007;29:923–9. CrossRef
- Fletcher EC. The relationship between hypertension and obstructive sleep apnea: facts and theory. Am J Med. 1995;98:118–28. CrossRef
- Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84. CrossRef
- Wang W, Wei PL, Lee WJ, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15:648–54. CrossRef
- Clinical Predictors of Obstructive Sleep Apnea in Asian Bariatric Patients
Volume 20, Issue 1 , pp 30-35
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Obstructive sleep apnea
- Body mass index
- Neck circumference
- Epworth Sleep Scale
- Bariatric surgery
- Industry Sectors
- Author Affiliations
- 1. Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan, Republic of China
- 2. Department of International Business, Ching Yun University, Jhongli City, Taiwan, Republic of China
- 3. Department of Surgery, Min-Sheng General Hospital, National Taiwan University, No. 168, Ching Kuo Road, Taoyuan, Taiwan, Republic of China
- 4. Center of Respiratory Care, Min-Sheng General Hospital, Taoyuan, Taiwan, Republic of China
- 5. Center of Sleep Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan, Republic of China