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Obesity Surgery

, Volume 17, Issue 6, pp 809–814 | Cite as

Prevalence and Severity of Sleep Apnea in a Group of Morbidly Obese Patients

  • Carla Daltro
  • Paloma Baiardi Gregorio
  • Erivaldo Alves
  • Maurício Abreu
  • Daniel Bomfim
  • Maria Helena Chicourel
  • Leila Araújo
  • Helma P. Cotrim
Article

Background

Obesity is the most important risk factor for obstructive sleep apnea. It is estimated that 70% of sleep apnea patients are obese. In the morbidly obese, the prevalence may reach 80% in men and 50% in women. The aim of this study was to determine the prevalence and severity of sleep apnea in a group of morbidly obese patients, leading to bariatric surgery.

Methods

In a cross-sectional study developed in Bahia, northeastern Brazil. 108 patients (78 women and 30 men) from the Obesity Treatment and Surgery Center - “Núcleo de Tratamento e Cirurgia da Obesidade” underwent standard polysomnography. Patients with an apnea-hypopnea index (AHI) ≥ 5 events/hour were considered apneic.

Results

Mean ± SD for age and BMI were 37.1 ± 10.2 years and 45.2 ± 5.4 kg/m2, respectively. The calculated AHI ranged widely from 2.5 to 128.9 events/hour. Sleep apnea was detected in 93.6% of the sample, wherein 35.2% had mild, 30.6% moderate and 27.8% severe apnea. Oxyhemoglobin desaturation was directly related to the AHI and was more severe in men.

Conclusion

There was a high frequency of sleep apnea in this group of morbidly obese patients, for whom it was very important to request polysomnography, thus enabling therapeutic management and prognostication.

Key words

Oxyhemoglobin desaturation morbid obesity obesity surgery polysomnography apnea-hypopnea index 

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References

  1. 1.
    WHO, World Health Organization. Obesity: preventing and managing the Global Epidemic. Report of a WHO Consultation on obesity, Geneva, 1997.Google Scholar
  2. 2.
    The Report of an American Academy of Sleep Disorders Medical Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22: 667–89.Google Scholar
  3. 3.
    Young T, Palta M, Dempsey J et al. The occurrence of sleep-disordered breathing among middle-age adults. N Engl J Med 1993; 328: 1230–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Malhotra A, White DP. Obstructive sleep apnoea. Lancet 2002; 360: 237–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Daltro CHC, Fontes FHO, Santos-Jesus R et al. Obstructive sleep apnea and hypopnea syndrome (OSAHS): association with obesity, gender and age. Arq Bras Endocrinol Metabol 2006; 50: 74–81.PubMedGoogle Scholar
  6. 6.
    Salvador J, Iriarte J, Silva C et al. The obstructive sleep apnoea syndrome in obesity: a conspirator in the shadow. Rev Med Univ Navarra 2004; 48: 55–62.PubMedGoogle Scholar
  7. 7.
    Ballantyne GH, Svahn J, Capella JF et al. Predictors of prolonged hospital stay following open and laparoscopic gastric bypass for morbid obesity: body mass index, length of surgery, sleep apnea, asthma, and the metabolic syndrome. Obes Surg 2004; 14: 1042–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Deutzer J. Potential complications of obstructive sleep apnea in patients undergoing gastric bypass surgery. Crit Care Nurs Q 2005; 28: 293–9.PubMedGoogle Scholar
  9. 9.
    Jain SS, Dhand R. Perioperative treatment of patients with obstructive sleep apnea. Curr Opin Pulm Med 2004; 10: 482–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Perugini RA, Mason R, Czerniach DR et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 2003; 138: 541–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Garrow JS, Webster J. Quetelet’s index (W/H2) as a measure of fatness. Int J Obes 1985; 9: 147–53.PubMedGoogle Scholar
  12. 12.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14: 540–5.PubMedGoogle Scholar
  13. 13.
    Rechtschaffen A, Kales A. A manual of standardized terminology, techniques, and scoring system for sleep stages in human subjects. Brain Information Service, UCLA: Los Angeles; 196.Google Scholar
  14. 14.
    Peiser J, Lavie P, Ovnat A, et al. Sleep apnea syndrome in the morbidly obese as an indication for weight reduction surgery. Ann Surg 1984; 199: 112–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Van Boxem TJM, DeGroot GH. Prevalence and severity of sleep disordered breathing in a group of morbidly obese patients. Neth J Med 1999; 54: 202–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Rajala R, Partinen M, Sane T et al. Obstructive sleep apnea in morbidly obese patients. J Intern Med 1991; 230: 125–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Valencia-Flores M, Orea A, Castaño VA et al. Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients. Obes Res 2000; 8: 262–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Frey WC, Pilcher J. Obstructive sleep-related breathing disorders in patients evaluated for bariatric surgery. Obes Surg 2003; 13: 676–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Manser RL, Rochford P, Pierce RJ et al. Impact of different criteria for defining hypopneas in the apneahypopnea index. Chest 2001; 120: 909–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Zafar S, Ayappa I, Norman RG et al. Choice of oximeter affects apnea-hypopnea index. Chest 2005; 127: 80–8.PubMedCrossRefGoogle Scholar
  21. 21.
    O’Keeffe T, Patterson EJ. Evidence supporting routine polysomnography before bariatric surgery. Obes Surg 2004; 14: 23–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Tung A, Rock P. Perioperative concerns in sleep apnea. Curr Opin Anaesthesiol 2001; 14: 671–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Weinbroum AA, Ben-Abraham R. Dextromethorphan and dexmedetomidine: new agents for control of perioperative pain. Eur J Surg 2001; 167: 563–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Hofer RE, Sprung J, Sarr MG et al. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anaesth 2005; 52: 176–80.PubMedCrossRefGoogle Scholar
  25. 25.
    Ramsey MA, Saha D, Hebeler RF. Tracheal resection in the morbidly obese patient: the role of dexmedetomidine. J Clin Anesth 2006; 18: 452–4.CrossRefGoogle Scholar
  26. 26.
    McCarty TM, Arnold DT, Lamont JP et al. Optimizing outcomes in bariatric surgery outpatient laparoscopic gastric bypass. Ann Surg 2005; 242: 494–501.PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Carla Daltro
    • 1
    • 6
  • Paloma Baiardi Gregorio
    • 2
  • Erivaldo Alves
    • 3
  • Maurício Abreu
    • 4
  • Daniel Bomfim
    • 4
  • Maria Helena Chicourel
    • 4
  • Leila Araújo
    • 5
  • Helma P. Cotrim
    • 5
  1. 1.Professor, Bahiana School of Medicine and Public Health, Department of Internal MedicineBahiaBrazil
  2. 2.Doctor of Cardio Pulmonary Sleep LaboratoryBahiaBrazil
  3. 3.Surgeon of Obesity Treatment and Surgery CenterBahiaBrazil
  4. 4.Medical Student at Bahiana School of Medicine and Public HealthBahiaBrazil
  5. 5.Professor, Bahia, Federal University of Medicine, Department of Internal MedicineBahiaBrazil
  6. 6.Rua Clarival do Prado ValladaresBahiaBrazil

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