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Obesity Surgery

, Volume 29, Issue 2, pp 601–608 | Cite as

Improvement in Nocturnal Hypoxemia in Obese Patients with Obstructive Sleep Apnea after Bariatric Surgery: a Meta-Analysis

  • Yuxiang Zhang
  • Wenyue Wang
  • Chengcan Yang
  • Jiahui Shen
  • Meilong Shi
  • Bing WangEmail author
Original Contributions
First Online:
  • 83 Downloads

Abstract

Objective

To conduct a meta-analysis examining the effects of bariatric surgery on nocturnal hypoxemia in obese patients with obstructive sleep apnea (OSA).

Methods

PubMed, EMBASE, Cochrane Library, and Web of Science were searched (the last search date was June 10, 2018) to identify relevant clinical studies. The mean arterial oxygen saturation (MeanSaO2), nadir oxygen saturation (NadirSaO2), apnea hypopnea index (AHI), and body mass index (BMI) data during the perioperative period were extracted and analyzed using a random effects model. Then, we performed subgroup and sensitivity analyses and calculated the publication bias to assess the between-study heterogeneity.

Results

In total, 15 studies with 636 patients were included; 13 were prospective observational trials, 1 was a randomized controlled trial (RCT), and 1 was a retrospective trial. After surgery, the MeanSaO2 and NadirSaO2 increased by 1.36 [95% CI (0.72, 2.00)] and 1.08 [95% CI (0.68, 1.49)], respectively, and the AHI and BMI decreased by 1.11 [95% CI (0.82, 1.40)] and 1.97 [95% CI (1.67, 2.27)], respectively. However, the heterogeneity across all trials was high; we identified some of the sources of that heterogeneity through subsequent subgroup and sensitivity analyses.

Conclusions

Bariatric surgery is effective at improving nocturnal hypoxemia in obese patients with OSA; it also reduces body weight and the number of apnea events. More randomized controlled and comparative trials are necessary in the future to confirm our findings and to explore the potential underlying mechanisms.

Keywords

Meta-analysis Bariatric surgery Obstructive sleep apnea Nocturnal hypoxemia Apnea hypopnea index 
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Notes

Acknowledgements

Many thanks to the patience and support from my tutor, professor Wang.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there are no conflicts of interest.

Ethical Approval

For this type of study, formal consent is not required.

Financial Disclosure

None.

Supplementary material

11695_2018_3573_MOESM1_ESM.docx (1.1 mb)
ESM 1 (DOCX 1170 kb)

References

  1. 1.
    Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.Google Scholar
  2. 2.
    Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol (1985). 2005;99(4):1592–9.Google Scholar
  3. 3.
    Tishler PV, Larkin EK, Schluchter MD, et al. Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing. JAMA. 2003;289(17):2230–7.Google Scholar
  4. 4.
    Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217–39.Google Scholar
  5. 5.
    Capdevila OS, Kheirandish-Gozal L, Dayyat E, et al. Pediatric obstructive sleep apnea: complications, management, and long-term outcomes. Proc Am Thorac Soc. 2008;5(2):274–82.Google Scholar
  6. 6.
    Jakobsen GS, Smastuen MC, Sandbu R, et al. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. JAMA. 2018;319(3):291–301.Google Scholar
  7. 7.
    Ikramuddin S, Korner J, Lee WJ, et al. Lifestyle intervention and medical management with vs without roux-en-Y gastric bypass and control of hemoglobin A1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study. JAMA. 2018;319(3):266–78.Google Scholar
  8. 8.
    Peromaa-Haavisto P, Tuomilehto H, Kossi J, et al. Obstructive sleep apnea: the effect of bariatric surgery after 12 months. A prospective multicenter trial. Sleep Med. 2017;35:85–90. EnglishGoogle Scholar
  9. 9.
    Del Genio G, Limongelli P, Del Genio F, et al. Sleeve gastrectomy improves obstructive sleep apnea syndrome (OSAS): 5 year longitudinal study. Surg Obes Relat Dis. 2016;12(1):70–4.Google Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    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.Google Scholar
  12. 12.
    Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–8. EnglishGoogle Scholar
  13. 13.
    Krieger AC, Youn H, Modersitzki F, et al. Effects of laparoscopic adjustable gastric banding on sleep and metabolism: a 12-month follow-up study. Int J Gen Med. 2012;5:975–81.Google Scholar
  14. 14.
    Fredheim JM, Rollheim J, Sandbu R, et al. Obstructive sleep apnea after weight loss: a clinical trial comparing gastric bypass and intensive lifestyle intervention. J Clin Sleep Med. 2013;9(5):427–32. EnglishGoogle Scholar
  15. 15.
    Bae EK, Lee YJ, Yun CH, et al. Effects of surgical weight loss for treating obstructive sleep apnea. Sleep Breath. 2014;18(4):901–5.Google Scholar
  16. 16.
    Ravesloot MJL, Hilgevoord AAJ, Van Wagensveld BA, et al. Assessment of the effect of bariatric surgery on obstructive sleep apnea at two postoperative intervals. Obes Surg. 2014;24(1):22–31. EnglishGoogle Scholar
  17. 17.
    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(8):1446–53.Google Scholar
  18. 18.
    Jiao X, Zou J, Zhang P, et al. Roux-en-Y gastric bypass surgery on obstructive sleep apnea-hypopnea syndrome: factors associated with postoperative efficacy. Obes Surg. 2016;26(12):2924–30.Google Scholar
  19. 19.
    Shaarawy H, Sarhan A. A ELH. Assessment of the effect of bariatric surgery on severe obstructive sleep apnea patients not tolerating CPAP therapy. Egyptian Journal of Chest Diseases and Tuberculosis. 2016;65(3):661–6. EnglishGoogle Scholar
  20. 20.
    Suliman LAM, Abdalla DA. Does sleeve gastrectomy improve obstructive sleep apnea? Egyptian Journal of Chest Diseases and Tuberculosis. 2016;65(2):505–10. EnglishGoogle Scholar
  21. 21.
    Amin R, Simakajornboon N, Szczesniak R, et al. Early improvement in obstructive sleep apnea and increase in orexin levels after bariatric surgery in adolescents and young adults. Surg Obes Relat Dis. 2017;13(1):95–100.Google Scholar
  22. 22.
    Aguiar I, Freitas W, Santos I, Apostolico N, Nacif S, Urbano J, et al. Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial. Multidiscip Respir Med. 2014;9(1) (no pagination).Google Scholar
  23. 23.
    Guardiano SA, Scott JA, Ware JC, et al. The long-term results of gastric bypass on indexes of sleep apnea. Chest. 2003;124(4):1615–9.Google Scholar
  24. 24.
    Fredheim JM, Rollheim J, Hofsø D, et al. The effect of intensive lifestyle intervention and bariatric surgery on moderate to severe obstructive sleep apnea in morbidly obese patients: A non-randomised clinical trial. Obes Facts. 2012;5:229. EnglishGoogle Scholar
  25. 25.
    Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.Google Scholar
  26. 26.
    McEvoy RD, Antic NA, Heeley E, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375(10):919–31.Google Scholar
  27. 27.
    Engleman H, Wild M. Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev. 2003;7(1):81–99.Google Scholar
  28. 28.
    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(7):1095–109.Google Scholar
  29. 29.
    Aurora RN, Crainiceanu C, Gottlieb DJ, et al. Obstructive sleep apnea during REM sleep and cardiovascular disease. Am J Respir Crit Care Med. 2018;197(5):653–60.Google Scholar
  30. 30.
    Simpson L, Mukherjee S, Cooper MN, et al. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. Sleep. 2010;33(4):467–74.Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General Surgery, Shanghai Ninth People’s HospitalShanghai JiaoTong University School of MedicineShanghaiChina

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