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Does Surgically Induced Weight Loss Improve Daytime Sleepiness?

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Abstract

Morbid obesity is associated with excessive daytime sleepiness and reduced health-related quality of life. We prospectively evaluated the pre- and postoperative responses of bariatric surgery recipients with the Epworth Sleepiness Scale (ESS) and the Short Form-12. Participants (n = 223; 79% women) with a mean body mass index (BMI) and ESS of 44.8 ± 7.9 kg/m2 and 7.9 ± 4.5, respectively, received a vertical gastrectomy (76%) or Roux-en-Y gastric bypass (12%). Preoperatively, 30% of patients complained of excessive daytime sleepiness (ESS > 10). Patients with preoperative excessive daytime sleepiness were more obese (p = 0.002), had higher fasting glucose levels (p = 0.02), more likely to have a diagnosis of sleep-disordered breathing (p < 0.001), report snoring (p < 0.001), and had lower health-related quality of life measures particularly physical function (p < 0.001), depression (p = 0.006), and sexual satisfaction (p = 0.04) than non-sleepy patients. At 12-months postoperatively, most patients experienced a significant reduction in BMI (28.6 ± 5.5 kg/m2, p < 0.001) and excessive daytime sleepiness (mean ESS 5.3 ± 3.3, p < 0.001). Patients with a clinically relevant improvement in the ESS at 12-months post-operatively had greater improvements in physical function (p = 0.009) and snoring (p = 0.010) and were more likely still using positive airway pressure therapy (p = 0.032) than patients without a clinically relevant improvement. Statistically and clinically significant improvements in all health-related quality of life measures were noted at 24 months. Bariatric surgery is associated with dramatic weight loss and improvements in physical functioning and daytime sleepiness.

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References

  1. Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13:329–30.

    Article  PubMed  Google Scholar 

  2. Flegal KM, Carrol MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723–7.

    Article  PubMed  Google Scholar 

  3. Mokdad AH, Bowman BA, Fe S, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286(10):1195–200.

    Article  PubMed  CAS  Google Scholar 

  4. Dansinger ML, Tatsioni A, Wong JB, et al. Meta-analysis: the effect of dietary counseling for weight loss. Ann Int Med. 2007;147:41–50.

    PubMed  Google Scholar 

  5. Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.

    Article  PubMed  CAS  Google Scholar 

  6. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  PubMed  CAS  Google Scholar 

  7. Dixon JB, Schachter L, O'Brien PE. Sleep disturbance and obesity. Changes following surgically induced weight loss. Arch Intern Med. 2001;161:102–6.

    Article  PubMed  CAS  Google Scholar 

  8. Bixler EO, Vgontzas AN, Lin HM, et al. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes and depression. J Clin Endocrinol Metab. 2005;90(8):4510–5.

    Article  PubMed  CAS  Google Scholar 

  9. Dixon JB, Dixon ME, Anderson ML, et al. Daytime sleepiness in the obese: not as simple as obstructive sleep apnea. Obesity. 2007;15(10):2504–11.

    Article  PubMed  Google Scholar 

  10. Resta O, Foschino Barbaro MP, Bonfitto P, et al. Low sleep quality and daytime sleepiness in obese patients without obstructive sleep apnoea syndrome. J Intern Med. 2003;253(5):536–43.

    Article  PubMed  CAS  Google Scholar 

  11. Vgontzas AN, Bixler EO, Tan TL, et al. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med. 1998;158(12):1333–7.

    Article  PubMed  CAS  Google Scholar 

  12. Vgontzas AN, Pejovic S, Zoumakis E, et al. Hypothalamic-pituitary-adrenal axis activity in obese men with and without sleep apnea: effects of continuous positive airway pressure therapy. J Clin Endocrinol Metab. 2007;92(11):4199–207.

    Article  PubMed  CAS  Google Scholar 

  13. Barcelo A, Barbe F, de la Pena M, et al. Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax. 2008;63(11):946–50.

    Article  PubMed  CAS  Google Scholar 

  14. Sharma SK, Kumpawat S, Goel A, et al. Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing. Sleep Med. 2007;8(1):12–7.

    Article  PubMed  CAS  Google Scholar 

  15. Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000;85(3):1151–8.

    Article  PubMed  CAS  Google Scholar 

  16. Lim W, Hong S, Nelesen R, et al. The association of obesity, cytokine levels, and depressive symptoms with diverse measures of fatigue in healthy subjects. Arch Intern Med. 2005;165(8):910–5.

    Article  PubMed  Google Scholar 

  17. Kapsimalis F, Basta M, Varouchakis G, et al. Cytokines and pathological sleep. Sleep Med. 2008;9(6):603–14.

    Article  PubMed  Google Scholar 

  18. Vgontzas AN, Lin HM, Papaliaga M, et al. Short sleep duration and obesity: the role of emotional stress and sleep disturbances. Int J Obes. 2008;32(5):801–9.

    Article  CAS  Google Scholar 

  19. Lyznicki JM, Doege TC, Davis RM, et al. Sleepiness, driving, and motor vehicle crashes. Council on Scientific Affairs, American Medical Association. Jama. 1998;279(23):1908–13.

    Article  PubMed  CAS  Google Scholar 

  20. Newman AB, Spiekerman CF, Enright P, et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group. J Am Geriatr Soc. 2000;48(2):115–23.

    PubMed  CAS  Google Scholar 

  21. Empana JP, Dauvilliers Y, Dartigues JF, et al. Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study. Stroke. 2009;40(4):1219–24.

    Article  PubMed  Google Scholar 

  22. Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med. 2002;251(3):207–16.

    Article  PubMed  CAS  Google Scholar 

  23. Lindberg E, Janson C, Svardsudd K, et al. Increased mortality among sleepy snorers: a prospective population based study. Thorax. 1998;53(8):631–7.

    Article  PubMed  CAS  Google Scholar 

  24. Dixon JB, Schachter LM, O'Brien PE. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes. 2005;29(9):1048–54.

    Article  CAS  Google Scholar 

  25. Anonymous. Gastrointestinal surgery for severe obesity. NIH Consens Statement Online. 1991;9(1):1–20.

    Google Scholar 

  26. Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes. 2008;6:11.

    Article  PubMed  Google Scholar 

  27. Jenkinson C, Layte R, Jenkinson D, et al. A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med. 1997;19(2):179–86.

    PubMed  CAS  Google Scholar 

  28. Muller-Nordhorn J, Nolte CH, Rossnagel K, et al. The use of the 12-item short-form health status instrument in a longitudinal study of patients with stroke and transient ischaemic attack. Neuroepidemiology. 2005;24(4):196–202.

    Article  PubMed  Google Scholar 

  29. Muller-Nordhorn J, Roll S, Willich SN. Comparison of the short form (SF)-12 health status instrument with the SF-36 in patients with coronary heart disease. Heart. 2004;90(5):523–7.

    Article  PubMed  CAS  Google Scholar 

  30. Ware Jr JE, Bayliss MS, Rogers WH, et al. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA. 1996;276(13):1039–47.

    Article  PubMed  Google Scholar 

  31. Li C, Friedman B, Conwell Y, et al. Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. J Am Geriatr Soc. 2007;55(4):596–602.

    Article  PubMed  Google Scholar 

  32. Whooley MA, Avins AL, Miranda J, et al. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12(7):439–45.

    Article  PubMed  CAS  Google Scholar 

  33. Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.

    PubMed  CAS  Google Scholar 

  34. Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–5.

    PubMed  CAS  Google Scholar 

  35. Kapur VK, Baldwin CM, Resnick HE, et al. Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep. 2005;28(4):472–7.

    PubMed  Google Scholar 

  36. Gottlieb DJ, Whitney CW, Bonekat WH, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med. 1999;159(2):502–7.

    PubMed  CAS  Google Scholar 

  37. Punjabi NM, Bandeen-Roche K, Young T. Predictors of objective sleep tendency in the general population. Sleep. 2003;26(6):678–83.

    PubMed  Google Scholar 

  38. Knutson KL, Rathouz PJ, Yan LL, et al. Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: the CARDIA study. Sleep. 2006;29(11):1503–6.

    PubMed  Google Scholar 

  39. Sanford SD, Lichstein KL, Durrence HH, et al. The influence of age, gender, ethnicity, and insomnia on Epworth sleepiness scores: a normative US population. Sleep Med. 2006;7(4):319–26.

    Article  PubMed  Google Scholar 

  40. Buysse DJ, Hall ML, Strollo PJ, et al. Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med. 2008;4(6):563–71.

    PubMed  Google Scholar 

  41. Johns M, Hocking B. Daytime sleepiness and sleep habits of Australian workers. Sleep. 1997;20(10):844–9.

    PubMed  CAS  Google Scholar 

  42. Parkes JD, Chen SY, Clift SJ, et al. The clinical diagnosis of the narcoleptic syndrome. J Sleep Res. 1998;7(1):41–52.

    Article  PubMed  CAS  Google Scholar 

  43. White J, Cates C, Wright J. Continuous positive airways pressure for obstructive sleep apnoea. Cochrane Database Syst Rev. 2002(2):CD001106.

  44. Kingshott RN, Vennelle M, Coleman EL, et al. Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of residual excessive daytime sleepiness in the sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 2001;163(4):918–23.

    PubMed  CAS  Google Scholar 

  45. Anonymous. Randomized trial of modafinil for the treatment of pathological somnolence in narcolepsy. US Modafinil in Narcolepsy Multicenter Study Group. Ann Neurol. 1998;43(1):88–97.

    Article  Google Scholar 

  46. Puhan MA, Suarez A, Lo Cascio C, et al. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006;332(7536):266–70.

    Article  PubMed  Google Scholar 

  47. Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465–84.

    Article  PubMed  CAS  Google Scholar 

  48. Overall JE, Ahn C, Shivakumar C, et al. Problematic formulations of SAS PROC.MIXED models for repeated measurements. J Biopharm Stat. 1999;9(1):189–216.

    Article  PubMed  CAS  Google Scholar 

  49. Vinkers DJ, Gussekloo J, Stek ML, et al. Temporal relation between depression and cognitive impairment in old age: prospective population based study. Bmj. 2004;329(7471):881.

    Article  PubMed  Google Scholar 

  50. MacKinnon DP, Dwyer JH. Estimating mediated effects in prevention studies. Eval Rev. 1993;17(2):144–58.

    Article  Google Scholar 

  51. Carmelli D, Bliwise DL, Swan GE, et al. A genetic analysis of the Epworth Sleepiness Scale in 1560 World War II male veteran twins in the NAS-NRC Twin Registry. J Sleep Res. 2001;10(1):53–8.

    Article  PubMed  CAS  Google Scholar 

  52. Carmelli D, Bliwise DL, Swan GE, et al. Genetic factors in self-reported snoring and excessive daytime sleepiness: a twin study. Am J Respir Crit Care Med. 2001;164(6):949–52.

    PubMed  CAS  Google Scholar 

  53. Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–8.

    PubMed  Google Scholar 

  54. Haines KL, Nelson LG, Gonzalez R, et al. Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery. 2007;141(3):354–8.

    Article  PubMed  Google Scholar 

  55. Varela JE, Hinojosa MW, Nguyen NT. Resolution of obstructive sleep apnea after laparoscopic gastric bypass. Obes Surg. 2007;17(10):1279–82.

    Article  PubMed  Google Scholar 

  56. Busetto L, Enzi G, Inelmen EM, et al. Obstructive sleep apnea syndrome in morbid obesity: effects of intragastric balloon. Chest. 2005;128(2):618–23.

    Article  PubMed  Google Scholar 

  57. 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(1):58–61.

    Article  PubMed  Google Scholar 

  58. Lessov-Schlaggar CN, Bliwise DL, Krasnow RE, et al. Genetic association of daytime sleepiness and depressive symptoms in elderly men. Sleep. 2008;31(8):1111–7.

    PubMed  Google Scholar 

  59. Paudel ML, Taylor BC, Diem SJ, et al. Association between depressive symptoms and sleep disturbances in community-dwelling older men. J Am Geriatr Soc. 2008;56(7):1228–35.

    Article  PubMed  Google Scholar 

  60. Pallesen S, Nordhus IH, Omvik S, et al. Prevalence and risk factors of subjective sleepiness in the general adult population. Sleep. 2007;30(5):619–24.

    PubMed  Google Scholar 

  61. Aloia MS, Arnedt JT, Smith L, et al. Examining the construct of depression in obstructive sleep apnea syndrome. Sleep Med. 2005;6(2):115–21.

    Article  PubMed  Google Scholar 

  62. Lundt L. Use of the Epworth Sleepiness Scale to evaluate the symptom of excessive sleepiness in major depressive disorder. Gen Hosp Psychiatry. 2005;27(2):146–8.

    Article  PubMed  Google Scholar 

  63. Resnick HE, Carter EA, Aloia M, et al. Cross-sectional relationship of reported fatigue to obesity, diet, and physical activity: results from the third national health and nutrition examination survey. J Clin Sleep Med. 2006;2(2):163–9.

    PubMed  Google Scholar 

  64. Theorell-Haglow J, Lindberg E, Janson C. What are the important risk factors for daytime sleepiness and fatigue in women? Sleep. 2006;29(6):751–7.

    PubMed  Google Scholar 

  65. Kim H, Young T, Kim H, et al. Subjective daytime sleepiness: dimensions and correlates in the general population. Sleep. 2005;28(5):625–34.

    PubMed  Google Scholar 

  66. Nena E, Tsara V, Steiropoulos P, et al. Sleep-disordered breathing and quality of life of railway drivers in Greece. Chest. 2008;134(1):79–86.

    Article  PubMed  Google Scholar 

  67. Siccoli MM, Pepperell JC, Kohler M, et al. Effects of continuous positive airway pressure on quality of life in patients with moderate to severe obstructive sleep apnea: data from a randomized controlled trial. Sleep. 2008;31(11):1551–8.

    PubMed  Google Scholar 

  68. Welch KC, Scharf SM, Welch KC, et al. Construct validity for the Health Utilities Index in a sleep center. Sleep Breath. 2007;11(4):295–303.

    Article  PubMed  Google Scholar 

  69. Wang PC, Li HY, Shih TS, et al. Generic and specific quality-of-life measures in Taiwanese adults with sleep-disordered breathing. Otolaryngol Head Neck Surg. 2006;135(3):421–6.

    Article  PubMed  Google Scholar 

  70. Briones B, Adams N, Strauss M, et al. Relationship between sleepiness and general health status. Sleep. 1996;19(7):583–8.

    PubMed  CAS  Google Scholar 

  71. Gulbay BE, Acican T, Onen ZP, et al. Health-related quality of life in patients with sleep-related breathing disorders: relationship with nocturnal parameters, daytime symptoms and comorbid diseases. Respiration. 2008;75(4):393–401.

    Article  PubMed  Google Scholar 

  72. Weaver EM, Kapur V, Yueh B. Polysomnography vs self-reported measures in patients with sleep apnea. Arch Otolaryngol Head Neck Surg. 2004;130(4):453–8.

    Article  PubMed  Google Scholar 

  73. Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31(8):1248–61.

    Article  CAS  Google Scholar 

  74. Mathus-Vliegen EM. Long-term health and psychosocial outcomes from surgically induced weight loss: results obtained in patients not attending protocolled follow-up visits. Int J Obes. 2007;31(2):299–307.

    Article  CAS  Google Scholar 

  75. Dixon JB, Dixon ME, O'Brien PE. Quality of life after lap-band placement: influence of time, weight loss, and comorbidities. Obes Res. 2001;9(11):713–21.

    Article  PubMed  CAS  Google Scholar 

  76. Karason K, Lindroos AK, Stenlof K, et al. Relief of cardiorespiratory symptoms and increased physical activity after surgically induced weight loss: results from the Swedish Obese Subjects study. Arch Intern Med. 2000;160(12):1797–802.

    Article  PubMed  CAS  Google Scholar 

  77. Baldwin CM, Kapur VK, Holberg CJ, et al. Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study. Sleep. 2004;27(2):305–11.

    PubMed  Google Scholar 

  78. Fong SY, Ho CK, Wing YK. Comparing MSLT and ESS in the measurement of excessive daytime sleepiness in obstructive sleep apnoea syndrome. J Psychosom Res. 2005;58(1):55–60.

    Article  PubMed  CAS  Google Scholar 

  79. Chervin RD, Aldrich MS. The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea. Neurology. 1999;52(1):125–31.

    PubMed  CAS  Google Scholar 

  80. Chervin RD, Aldrich MS, Pickett R, et al. Comparison of the results of the Epworth Sleepiness Scale and the Multiple Sleep Latency Test. J Psychosom Res. 1997;42(2):145–55.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We thank Steve Cummings for his advice throughout this project, John Feng for his assistance with the bariatric procedures, Juliana van Cleve for her help with the data preparation, and Alice LaRocca for her administrative support. We are grateful to the bariatric patients who provided data for this study.

Conflicts of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. California Pacific Medical Center Research Center, San Francisco, CA, USA

    Neeta Parimi, Michael Ballesteros, Paul T. Cirangle, Gregg H. Jossart, Nicole D. Kimbrough, Jennifer M. Rose & Dena M. Bravata

  2. Center for Primary Care and Outcomes Research, Stanford University, San Francisco, CA, USA

    Jon-Erik Cleophas Holty & Dena M. Bravata

  3. Stanford Sleep Disorders Clinic, Stanford University School of Medicine, San Francisco, CA, USA

    Jon-Erik Cleophas Holty

  4. Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, VA Palo Alto Health Care System, 3801 Miranda Ave (111P), Palo Alto, CA, 94304, USA

    Jon-Erik Cleophas Holty

  5. Research Institute, California Pacific Medical Center, San Francisco, CA, USA

    Terri Blackwell & Katie L. Stone

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  1. Jon-Erik Cleophas Holty
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Correspondence to Jon-Erik Cleophas Holty.

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This project was supported by a grant from the Centers of Research in Clinical Excellence (CRCLE) from California Pacific Medical Center.

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Holty, JE.C., Parimi, N., Ballesteros, M. et al. Does Surgically Induced Weight Loss Improve Daytime Sleepiness?. OBES SURG 21, 1535–1545 (2011). https://doi.org/10.1007/s11695-010-0213-0

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