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Respiratory Considerations and Effect of Bariatric Surgery in the Obese Patient

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Obesity, Bariatric and Metabolic Surgery

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Abstract

Pulmonary function abnormalities are quite common in obesity. Consequently, in obese people, a number of respiratory comorbidities are seen, and they have to be identified and treated prior to bariatric surgery. The most commonly occurring conditions are obstructive sleep apnea (OSA), obesity hypoventilation syndrome, pulmonary hypertension, and asthma. Preoperative assessment includes a detailed history and clinical examination, followed by appropriate investigations to detect these comorbidities. OSA is highly prevalent in obese people undergoing bariatric surgery and should be considered in all patients during the preoperative evaluation. Screening tools and questionnaires are useful to identify patients with OSA although there are suggestions that all patients presenting for weight loss surgery should have a preoperative sleep study. Continuous positive airway pressure is the treatment of choice in moderate to severe OSA and should be instituted prior to surgery to reduce the risk of perioperative complications. Bariatric surgery can result in significant improvements in pulmonary function and resolution of some of the respiratory comorbidities such as OSA.

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References

  1. Zerah F, Harf A, Perlemuter L, et al. Effects of obesity on respiratory resistance. Chest. 1993;103:1470–6. https://doi.org/10.1378/chest.103.5.1470.

    Article  CAS  Google Scholar 

  2. Koenig SM. Pulmonary complications of obesity. Am J Med Sci. 2001;321:249–79. https://doi.org/10.1097/00000441-200104000-00006.

    Article  CAS  Google Scholar 

  3. Kress JP, Pohlman AS, Alverdy J, Hall JB. The impact of morbid obesity on oxygen cost of breathing (VO(2RESP)) at rest. Am J Respir Crit Care Med. 1999;160:883–6. https://doi.org/10.1164/ajrccm.160.3.9902058.

    Article  CAS  Google Scholar 

  4. Biring MS, Lewis MI, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318:293–7. https://doi.org/10.1097/00000441-199911000-00002.

    Article  CAS  Google Scholar 

  5. Ray CS, Sue DY, Bray G, et al. Effects of obesity on respiratory function. Am Rev Respir Dis. 1983;128:501–6. https://doi.org/10.1164/arrd.1983.128.3.501.

    Article  CAS  Google Scholar 

  6. Steier J, Lunt A, Hart N, et al. Observational study of the effect of obesity on lung volumes. Thorax. 2014;69:752–9. https://doi.org/10.1136/thoraxjnl-2014-205148.

    Article  Google Scholar 

  7. Holley HS, Milic-Emili J, Becklake MR, Bates DV. Regional distribution of pulmonary ventilation and perfusion in obesity. J Clin Invest. 1967;46:475–81. https://doi.org/10.1172/JCI105549.

    Article  CAS  Google Scholar 

  8. Steier J, Jolley CJ, Seymour J, et al. Neural respiratory drive in obesity. Thorax. 2009;64:719–25. https://doi.org/10.1136/thx.2008.109728.

    Article  CAS  Google Scholar 

  9. Li Y, Schwabe RF, DeVries-Seimon T, et al. Free cholesterol-loaded macrophages are an abundant source of tumor necrosis factor-α and Interleukin-6 model of NF-κB- and map kinase-dependent inflammation in advanced atherosclerosis. J Biol Chem. 2005;280:21763–72. https://doi.org/10.1074/jbc.M501759200.

    Article  CAS  Google Scholar 

  10. Resta O, Foschino-Barbaro MP, Legari G, et al. Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obes. 2001;25:669–75. https://doi.org/10.1038/sj.ijo.0801603.

    Article  CAS  Google Scholar 

  11. Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg. 2003;13:676–83. https://doi.org/10.1381/096089203322509228.

    Article  Google Scholar 

  12. Nowbar S, Burkart KM, Gonzales R, et al. Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome. Am J Med. 2004;116:1–7. https://doi.org/10.1016/j.amjmed.2003.08.022.

    Article  Google Scholar 

  13. Budweiser S, Riedl SG, Jörres RA, et al. Mortality and prognostic factors in patients with obesity-hypoventilation syndrome undergoing noninvasive ventilation. J Intern Med. 2007;261:375–83. https://doi.org/10.1111/j.1365-2796.2007.01765.x.

    Article  CAS  Google Scholar 

  14. Mokhlesi B, Kryger MH, Grunstein RR. Assessment and management of patients with obesity hypoventilation syndrome. Proc Am Thorac Soc. 2008;5:218–25. https://doi.org/10.1513/pats.200708-122MG.

    Article  Google Scholar 

  15. Shore SA. Obesity and asthma: implications for treatment. Curr Opin Pulm Med. 2007;13:56–62. https://doi.org/10.1097/MCP.0b013e3280110196.

    Article  Google Scholar 

  16. Gunnbjörnsdóttir MI, Omenaas E, Gíslason T, et al. Obesity and nocturnal gastro-oesophageal reflux are related to onset of asthma and respiratory symptoms. Eur Respir J. 2004;24:116–21. https://doi.org/10.1183/09031936.04.00042603.

    Article  Google Scholar 

  17. Abdollahi M, Cushman M, Rosendaal FR. Obesity: risk of venous thrombosis and the interaction with coagulation factor levels and oral contraceptive use. Thromb Haemost. 2003;89:493–8. https://doi.org/10.1055/s-0037-1613379.

    Article  CAS  Google Scholar 

  18. Carmody BJ, Sugerman HJ, Kellum JM, et al. Pulmonary embolism complicating bariatric surgery: detailed analysis of a single institution’s 24-year experience. J Am Coll Surg. 2006;203:831–7. https://doi.org/10.1016/j.jamcollsurg.2006.08.020.

    Article  Google Scholar 

  19. Friedman SE, Andrus BW. Obesity and pulmonary hypertension: a review of pathophysiologic mechanisms. J Obes. 2012;2012:505274. https://doi.org/10.1155/2012/505274.

    Article  Google Scholar 

  20. McQuillan BM, Picard MH, Leavitt M, Weyman AE. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation. 2001;104:2797–802. https://doi.org/10.1161/hc4801.100076.

    Article  CAS  Google Scholar 

  21. Taraseviciute A, Voelkel NF. Severe pulmonary hypertension in postmenopausal obese women. Eur J Med Res. 2006;11:198–202.

    Google Scholar 

  22. Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstructive sleep apnoea. Br J Anaesth. 2012;108:768–75. https://doi.org/10.1093/bja/aes022.

    Article  CAS  Google Scholar 

  23. Oliveros H, Lobelo R, Giraldo-Cadavid LF, et al. BASAN index (body mass index, age, sex, arterial hypertension and neck circumference) predicts severe apnoea in adults living at high altitude. BMJ Open. 2021;11:e044228. https://doi.org/10.1136/bmjopen-2020-044228.

    Article  Google Scholar 

  24. Nuckton TJ, Glidden DV, Browner WS, Claman DM. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep. 2006;29:903–8. https://doi.org/10.1093/sleep/29.7.903.

    Article  Google Scholar 

  25. Hamoui N, Anthone G, Crookes PF. The value of pulmonary function testing prior to bariatric surgery. Obes Surg. 2006;16:1570–3. https://doi.org/10.1381/096089206779319356.

    Article  Google Scholar 

  26. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5. https://doi.org/10.1093/sleep/14.6.540.

    Article  CAS  Google Scholar 

  27. Netzer NC, Stoohs RA, Netzer CM, et al. Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485–91. https://doi.org/10.7326/0003-4819-131-7-199910050-00002.

    Article  CAS  Google Scholar 

  28. Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013;23:2050–7. https://doi.org/10.1007/s11695-013-1006-z.

    Article  Google Scholar 

  29. Chung F, Yegneswaran B, Liao P, et al. Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008;108:822–30. https://doi.org/10.1097/ALN.0b013e31816d91b5.

    Article  Google Scholar 

  30. McArdle N, Devereux G, Heidarnejad H, et al. Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 1999;159:1108–14. https://doi.org/10.1164/ajrccm.159.4.9807111.

    Article  CAS  Google Scholar 

  31. Marti-Soler H, Hirotsu C, Marques-Vidal P, et al. The NoSAS score for screening of sleep-disordered breathing: a derivation and validation study. Lancet Respir Med. 2016;4:742–8. https://doi.org/10.1016/S2213-2600(16)30075-3.

    Article  Google Scholar 

  32. Duarte RLM, Rabahi MF, Magalhães-da-Silveira FJ, et al. Simplifying the screening of obstructive sleep apnea with a 2-item model, no-apnea: a cross-sectional study. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2018;14:1097–107. https://doi.org/10.5664/jcsm.7202.

    Article  Google Scholar 

  33. Mokhlesi B, Masa JF, Brozek JL, et al. Evaluation and management of obesity hypoventilation syndrome. An official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2019;200:e6–e24. https://doi.org/10.1164/rccm.201905-1071ST.

    Article  Google Scholar 

  34. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13:479–504. https://doi.org/10.5664/jcsm.6506.

    Article  Google Scholar 

  35. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999;22:667–89. https://doi.org/10.1093/sleep/22.5.667.

  36. Masa JF, Corral J, Pereira R, et al. Effectiveness of home respiratory polygraphy for the diagnosis of sleep apnoea and hypopnoea syndrome. Thorax. 2011;66:567–73. https://doi.org/10.1136/thx.2010.152272.

    Article  Google Scholar 

  37. de Raaff CAL, Gorter-Stam MAW, de Vries N, et al. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Relat Dis. 2017;13:1095–109. https://doi.org/10.1016/j.soard.2017.03.022.

    Article  Google Scholar 

  38. Peri-operative management of obstructive sleep apnea. Surg Obes Relat Dis. 2012;8:e27–32. https://doi.org/10.1016/j.soard.2012.03.003.

  39. Giles TL, Lasserson TJ, Smith BJ, et al. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006:CD001106. https://doi.org/10.1002/14651858.CD001106.pub2.

  40. Tomfohr LM, Ancoli-Israel S, Loredo JS, Dimsdale JE. Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial. Sleep. 2011;34:121–6. https://doi.org/10.1093/sleep/34.1.121.

    Article  Google Scholar 

  41. Piper AJ, Sullivan CE. Effects of short-term NIPPV in the treatment of patients with severe obstructive sleep apnea and hypercapnia. Chest. 1994;105:434–40. https://doi.org/10.1378/chest.105.2.434.

    Article  CAS  Google Scholar 

  42. Tong S, Gower J, Morgan A, et al. Noninvasive positive pressure ventilation in the immediate post-bariatric surgery care of patients with obstructive sleep apnea: a systematic review. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13:1227–33. https://doi.org/10.1016/j.soard.2017.02.009.

    Article  Google Scholar 

  43. Reijers SNH, Nijland LMG, Bosschieter PFN, et al. The effect of postoperative CPAP use on anastomotic and staple line leakage after bariatric surgery. Sleep Breath Schlaf Atm. 2020; https://doi.org/10.1007/s11325-020-02199-7.

  44. Bignold JJ, Deans-Costi G, Goldsworthy MR, et al. Poor long-term patient compliance with the tennis ball technique for treating positional obstructive sleep apnea. J Clin Sleep Med. 2009;5:428–30.

    Article  Google Scholar 

  45. Ravesloot MJL, White D, Heinzer R, et al. Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med. 2017;13:813–24. https://doi.org/10.5664/jcsm.6622.

    Article  Google Scholar 

  46. Di Lorenzo N, Antoniou SA, Batterham RL, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc. 2020;34:2332–58. https://doi.org/10.1007/s00464-020-07555-y.

    Article  Google Scholar 

  47. Dávila-Cervantes A, Domínguez-Cherit G, Borunda D, et al. Impact of surgically-induced weight loss on respiratory function: a prospective analysis. Obes Surg. 2004;14:1389–92. https://doi.org/10.1381/0960892042583996.

    Article  Google Scholar 

  48. Refsum HE, Holter PH, Løvig T, et al. Pulmonary function and energy expenditure after marked weight loss in obese women: observations before and one year after gastric banding. Int J Obes. 1990;14:175–83.

    CAS  Google Scholar 

  49. Timmerman M, Basille D, Basille-Fantinato A, et al. Short-term assessment of obstructive sleep apnea syndrome remission rate after sleeve gastrectomy: a cohort study. Obes Surg. 2019;29:3690–7. https://doi.org/10.1007/s11695-019-04110-0.

    Article  Google Scholar 

  50. Wong A-M, Barnes HN, Joosten SA, et al. The effect of surgical weight loss on obstructive sleep apnoea: a systematic review and meta-analysis. Sleep Med Rev. 2018;42:85–99. https://doi.org/10.1016/j.smrv.2018.06.001.

    Article  Google Scholar 

  51. Hariri K, Kini SU, Herron DM, Fernandez-Ranvier G. Resolution of symptomatic obstructive sleep apnea not impacted by preoperative body mass index, choice of operation between sleeve gastrectomy and Roux-en-Y gastric bypass surgery, or severity. Obes Surg. 2018;28:1402–7. https://doi.org/10.1007/s11695-017-3042-6.

    Article  Google Scholar 

  52. Ravesloot MJL, Hilgevoord AAJ, van Wagensveld BA, de Vries N. Assessment of the effect of bariatric surgery on obstructive sleep apnea at two postoperative intervals. Obes Surg. 2014;24:22–31. https://doi.org/10.1007/s11695-013-1023-y.

    Article  CAS  Google Scholar 

  53. Sillo TO, Lloyd-Owen S, White E, et al. The impact of bariatric surgery on the resolution of obstructive sleep apnoea. BMC Res Notes. 2018;11:385. https://doi.org/10.1186/s13104-018-3484-5.

    Article  Google Scholar 

  54. Zou J, Zhang P, Yu H, et al. Effect of laparoscopic Roux-en-Y gastric bypass surgery on obstructive sleep apnea in a Chinese population with obesity and T2DM. Obes Surg. 2015;25:1446–53. https://doi.org/10.1007/s11695-014-1510-9.

    Article  Google Scholar 

  55. Scheuller M, Weider D. Bariatric surgery for treatment of sleep apnea syndrome in 15 morbidly obese patients: long-term results. Otolaryngol Head Neck Surg. 2001;125:299–302. https://doi.org/10.1067/mhn.2001.119139.

    Article  CAS  Google Scholar 

  56. Dalmar A, Singh M, Pandey B, et al. The beneficial effect of weight reduction on adverse cardiovascular outcomes following bariatric surgery is attenuated in patients with obstructive sleep apnea. Sleep. 2018; https://doi.org/10.1093/sleep/zsy028.

  57. Valencia-Flores M, Orea A, Herrera M, et al. Effect of bariatric surgery on obstructive sleep apnea and hypopnea syndrome, electrocardiogram, and pulmonary arterial pressure. Obes Surg. 2004;14:755–62. https://doi.org/10.1381/0960892041590773.

    Article  Google Scholar 

  58. Sugerman HJ, Baron PL, Fairman RP, et al. Hemodynamic dysfunction in obesity hypoventilation syndrome and the effects of treatment with surgically induced weight loss. Ann Surg. 1988;207:604–13. https://doi.org/10.1097/00000658-198805000-00015.

    Article  CAS  Google Scholar 

  59. Macgregor AM, Greenberg RA. Effect of surgically induced weight loss on asthma in the morbidly obese. Obes Surg. 1993;3:15–21. https://doi.org/10.1381/096089293765559700.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Respiratory Medicine, Barking, Havering and Redbridge University Hospitals, Essex, UK

    Manoj K. Menon

  2. Department of Respiratory Medicine, Homerton University Hospital, London, UK

    Angshu Bhowmik

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  1. Manoj K. Menon
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  2. Angshu Bhowmik
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Correspondence to Angshu Bhowmik .

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Editors and Affiliations

  1. Homerton University Hospital, London, UK

    Sanjay Agrawal

Section Editor information

  1. Department of Bariatric Surgery, St Georges Hospital, London, UK

    Omar Khan MA, PhD, FRCS

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Menon, M.K., Bhowmik, A. (2023). Respiratory Considerations and Effect of Bariatric Surgery in the Obese Patient. In: Agrawal, S. (eds) Obesity, Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-60596-4_67

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  • DOI: https://doi.org/10.1007/978-3-030-60596-4_67

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