Obesity Surgery

, Volume 19, Issue 6, pp 796–801 | Cite as

Obstructive Sleep Apnea–Hypopnea Syndrome—The Role of Bariatric and Maxillofacial Surgeries

  • Marconi Eduardo Sousa Maciel Santos
  • Nelson Studart Rocha
  • José Rodrigues Laureano FilhoEmail author
  • Edmundo Machado Ferraz
  • Josemberg Marins Campos


Obstructive sleep apnea–hypopnea syndrome (OSAHS) is a complex disease with multifactorial etiology. It is marked by the occurrence of apnea and hypopnea events caused by repeated obstructions of the upper airways. OSAHS is strongly associated with obesity, and the prevalence of this disease in morbidly obese patients is very high. Nevertheless, not all patients with OSAHS are obese, and for this reason, there may be other anatomical predispositions to airway collapse. In obese patients, fatty deposition in the parapharyngeal region results in airway reduction and predisposes to airway collapse, worsened by neurologic loss of the normal dilator muscle tone of the neck. However, in nonobese patients, specific craniofacial characteristics such as posterior air pharyngeal space, tongue length, hyoid position, and maxillomandibular deficiencies may predispose some people to develop OSAHS. Treatment strategies for OSAHS patients vary from clinical treatment with continuous positive airway pressure, oral appliances, or medications for mild and moderate OSAHS patients, bariatric surgery for severe obese OSAHS patients to maxillomandibular advancement for obese or nonobese OSAHS patients.


Sleep apnea Obstructive Obesity Bariatric surgery Facial asymmetry Mandibular advancement 


  1. 1.
    World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO convention, Geneva, 1999. WHO technical report series 894, Geneva 2000.Google Scholar
  2. 2.
    Fristcher LG, Mottin CC, Canani S, et al. Obesity and obstructive sleep apnea-hypopnea syndrome: the impact of bariatric surgery. Obes Surg. 2007;17:95–9.CrossRefGoogle Scholar
  3. 3.
    Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17(6):809–14.CrossRefGoogle Scholar
  4. 4.
    Fleisher KE, Krieger AC. Current trends in the treatment of obstructive sleep apnea. J Oral Maxillofac Surg. 2007;65:2056–68.CrossRefGoogle Scholar
  5. 5.
    Fritscher LG, Canani S, Mottin CC, et al. Bariatric surgery in the treatment of obstructive sleep apnea in morbidly obese patients. Respiration. 2007;74(6):647–52.CrossRefGoogle Scholar
  6. 6.
    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.CrossRefGoogle Scholar
  7. 7.
    Santiago-Recuerda A, Gómez-Terreros FJ, Caballero P, et al. Relationship between upper airway and obstrutive sleep apnea-hypopnea syndrome in morbidly obese women. Obes Surg. 2007;17:689–97.CrossRefGoogle Scholar
  8. 8.
    Pae EK, Ferguson KA. Cephalometric characteristics of nonobese patients with severe OSA. Angle Orthod. 1999;69(5):408–12.PubMedGoogle Scholar
  9. 9.
    Fairburn SC, Waite PD, Vilos G, et al. Three-dimensional changes in upper airways of patients with obstructive sleep apnea following maxilomandibular advancement. J Oral Maxillofac Surg. 2007;65:6–12.CrossRefGoogle Scholar
  10. 10.
    Li KK, Guilleminault C, Riley RW, et al. Obstructive sleep apnea and maxilomandibular advancement: an assessment of airway changes using radiographic and nasopharyngoscopic examinations. J Oral Maxillofac Surg. 2002;60:526–30.CrossRefGoogle Scholar
  11. 11.
    Goldberg AN, Schwab RJ. Identifying the patient with sleep apnea. Upper airway assessment and physical examination. Otolaryngol Clin N Am 1998;31(6):919–30.CrossRefGoogle Scholar
  12. 12.
    Hou HM, Hägg U, Sam K, et al. Dentofacial characteristics of Chinese obstructive sleep apnea patients on relation to obesity and severity. Angle Orthod. 2006;76(6):962–9.CrossRefGoogle Scholar
  13. 13.
    Bian H. Knowledge, opinions, and clinical experience of general practice dentists toward obstructive sleep apnea and oral appliances. Sleep Breath. 2004;8(2):85–90.CrossRefGoogle Scholar
  14. 14.
    Kempers KG, Foote JW, Diflorio-Brennan T. Obesity: prevalence and considerations in oral and maxillofacial surgery. J Oral Maxillofac Surg. 2000;58:137–43.CrossRefGoogle Scholar
  15. 15.
    Branca F, Nikogosian H, Lobstein T, World Health Organization. The challenge of obesity in the WHO European region and the strategies for response. WHO Library Cataloguing in Publication Data, 323, Copenhagen, 2007.Google Scholar
  16. 16.
    Moore KE, Esther MS. Current medical management of sleep-related breathing disorders. Oral Maxillofac Surg Clin North Am. 2002;14:297–304.CrossRefGoogle Scholar
  17. 17.
    Badr MS. Pathophysiology of obstructive sleep apnea. Oral Maxillofac Surg Clin North Am. 2002;14:285–92.CrossRefGoogle Scholar
  18. 18.
    Yucel A, Unlu M, Haktanir A, et al. Evaluation of the upper airway cross-sectional area changes in different degrees of severity of obstructive sleep apnea syndrome: cephalometric and dynamic CT study. AJNR Am J Neuroradiol. 2005;26:2624–9.PubMedGoogle Scholar
  19. 19.
    Paoli JR, Lauwers F, Lacassagne L, et al. Craniofacial differences according to the body mass index of patients with obstructive sleep apnoea syndrome: cephalometric study in 85 patients. Br J Oral Maxillofac Surg. 2001;39:40–5.CrossRefGoogle Scholar
  20. 20.
    Tangugsorn V, Krogstad O, Espeland L, et al. Obstructive sleep apnoea: multiple comparisons of cephalometric variables of obese and non-obese patients. J Craniomaxillofac Surg. 2000;28(4):204–12.CrossRefGoogle Scholar
  21. 21.
    Tangugsorn V, Krogstad O, Espeland L, et al. Obstructive sleep apnea (OSA): a cephalometric analysis of severe and non-severe OSA patients. Part I: multiple comparison of cephalometric variables. Int J Adult Orthodon Orthognath Surg. 2000;15(2):139–52.PubMedGoogle Scholar
  22. 22.
    Battagel JM, Johal A, Kotecha B. A cephalometric comparison of subjects with snoring and obstructive sleep apnoea. Eur J Orthod. 2000;22:353–62.CrossRefGoogle Scholar
  23. 23.
    Malhotra A, Trinder J, Fogel R, et al. Postural effects on pharyngeal protective mechanisms. Sleep. 2004;27:1105.CrossRefGoogle Scholar
  24. 24.
    Marik P. Leptin, obesity, and obstructive sleep apnea. Chest. 2000;118:569–71.CrossRefGoogle Scholar
  25. 25.
    Li KK. Controversy in surgical versus nonsurgical treatment of obstructive sleep apnea syndrome. J Oral Maxillofac Surg. 2006;64:1267–8.CrossRefGoogle Scholar
  26. 26.
    Schwab RJ. Controversy in surgical versus nonsurgical treatment of obstructive sleep apnea syndrome. J Oral Maxillofac Surg. 2006;64:1269–71.CrossRefGoogle Scholar
  27. 27.
    Hoekema A, Lange J, Stegenga B, et al. Oral appliances and maxillomandibular advancement surgery: an alternative treatment protocol for the obstructive sleep apnea-hypopnea syndrome. J Oral Maxillofac Surg. 2006;64:886–91.CrossRefGoogle Scholar
  28. 28.
    Hendler BH, Costello BJ, Silverstein K, et al. A protocol for uvulopalatopharyngoplasty, mortised genioplasty, and maxillomandibular advancement in patients with obstructive sleep apnea: an analysis of 40 cases. J Oral Maxillofac Surg. 2001;59:892–7.CrossRefGoogle Scholar
  29. 29.
    Gilon Y, Raskin S, Heymans O, et al. Surgical management of maxillomandibular advancement in sleep apnea patients: specific technical considerations. Int J Adult Orthodon Orthognath Surg. 2001;16(4):305–14.PubMedGoogle Scholar
  30. 30.
    Brar PS. Maxillomandibular advancement surgery for treatment of moderate-severe obstructive sleep apnea: a systematic review. J Oral Maxillofac Surg. 2007;65(9):40.e8–9.CrossRefGoogle Scholar
  31. 31.
    Tselnik M, Pogrel MA. Assessment of the pharyngeal airway space after mandibular setback surgery. J Oral Maxillofac Surg. 2000;58:282–5.CrossRefGoogle Scholar
  32. 32.
    Kitagawara K, Kobayashi T, Goto H, et al. Effects of mandibular setback surgery on oropharyngeal airway and arterial oxygen saturation. Int J Oral maxillofac Surg. 2008;37:328–33.CrossRefGoogle Scholar
  33. 33.
    Gazayerli M, Bleibel W, Elhor A, et al. The shape of the epiglottis reflects improvement in upper airway obstruction after weight loss. Obes Surg 2006;16:945–7.CrossRefGoogle Scholar
  34. 34.
    Rama AN, Tekwami SH, Kushida CA. Sites of obstruction in obstructive sleep apnea. Chest 2002;122:1139.CrossRefGoogle Scholar
  35. 35.
    Almeida FR, Lowe AA, Sung JO, et al. Long-term sequelae of oral appliance therapy in obstructive sleep apnea patients: part 1. Cephalometric analysis. Am J Orthod Dentofacial Orthop 2006;129(2):195–204.CrossRefGoogle Scholar
  36. 36.
    Almeida FR, Lowe AA, Otsuka R, et al. Long-term sequelae of oral appliance therapy in obstructive sleep apnea patients: part 2. Study–model analysis. Am J Orthod Dentofacial Orthop 2006;129(2):205–13.CrossRefGoogle Scholar
  37. 37.
    Hammond RJ, Gotsopoulos H, Shen G, et al. A follow-up study of dental and skeletal changes associated with mandibular advancement splint use in obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2007;132(6):806–14.CrossRefGoogle Scholar
  38. 38.
    Hoekema A, Stegenga B, De Bont LG. Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review. Crit Rev Oral Biol Med. 2004;15(3):137–55.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Marconi Eduardo Sousa Maciel Santos
    • 1
  • Nelson Studart Rocha
    • 1
  • José Rodrigues Laureano Filho
    • 1
    Email author
  • Edmundo Machado Ferraz
    • 2
  • Josemberg Marins Campos
    • 2
  1. 1.Dentistry College of PernambucoUniversity of PernambucoCamaragibeBrazil
  2. 2.Division of General Surgery and Obesity Surgery, Clinics HospitalFederal University of PernambucoRecifeBrazil

Personalised recommendations