Abstract
Background
Studies have reported significant improvement of obstructive sleep apnea (OSA) in obese patients after bariatric surgery (BS). Weight loss following BS is rapid in the first few months, but it can take at least 1 year to reach the final result. The aim of this study is to measure the effect of BS on various clinical, respiratory, and sleep parameters of OSA at two postoperative intervals.
Methods
Prospectively, all patients being evaluated for BS underwent a polysomnography (PSG). Patients diagnosed with OSA preoperatively were invited to undergo a PSG at least 6 months postoperatively and if OSA persisted, again at least 12 months postoperatively.
Results
One hundred ten patients underwent a first postoperative PSG 7.7 months after surgery. The mean apnea–hypopnea index (AHI) significantly decreased from 39.5 to 15.6/h. In 58.2 %, the AHI was reduced to below 10 and in 25.5 % to below 5. Fifty patients underwent a first PSG 7.1 months and a second PSG 16.9 months after surgery. The mean AHI decreased from 49.1 to 22.7 to 17.4/h following BS.
Conclusions
BS initiates dramatic improvement and even remission of clinical and sleep parameters during the first 7 months, which continues at a slower rate over the next 10 months. We recommend a follow-up PSG after surgery to check for residual disease and if necessary retritration of continuous positive airway pressure, which may lead to higher treatment compliance.
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Abbreviations
- AI:
-
Apnea index
- AHI:
-
Apnea–hypopnea index
- BMI:
-
Body mass index
- BS:
-
Bariatric surgery
- CPAP:
-
Continuous positive airway pressure
- DI:
-
Desaturation index
- ENT:
-
Ear nose and throat
- ESS:
-
Epworth sleepiness scale
- IFSO:
-
International Federation for the Surgery of Obesity
- LAGB:
-
Laparoscopic gastric banding
- LRYGB:
-
Laparoscopic gastric bypass
- OHS:
-
Obesity hypoventilation syndrome
- OSA:
-
Obstructive sleep apnea
- PSG:
-
Polysomnography
- SaO2 :
-
Oxygen saturation
- SG:
-
Sleeve gastrectomy
- WHO:
-
World Health Organization
References
Young T, Palta M, Dempsey J, et al. The occurrence of sleep disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.
Ravesloot MJL, van Maanen JP, Hilgevoord AAJ, et al. Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol. 2012;269(7):1865–71.
Summers CL, Stradling JR, Baddeley RM. Treatment of sleep apnoea by vertical gastroplasty. Br J Surg. 1990;77(11):1271–2.
Rasheid S. Gastric bypass is an effective treatment for OSA in patients with clinically significant obesity. Obes Surg. 2003;13(1):58–61.
Sugerman HJ, Fairman RP, Sood RK, et al. Long-term effects of gastric surgery for treating respiratory insufficiency of obesity. Am J Clin Nutr. 1992;55(2 Suppl):597S–601S.
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.
Varela JE, Hinojosa MW, Nguyen NT. Resolution of obstructive sleep apnea after laparoscopic gastric bypass. Obes Surg. 2007;17(10):1279–82.
Rao A, Tey BH, Ramalingam G, et al. Obstructive sleep apnoea (OSA) patterns in bariatric surgical practice and response of OSA to weight loss after laparoscopic adjustable gastric banding (LAGB). Ann Acad Med Singap. 2009;38(7):587–93.
Dixon JB, Schachter LM, O’Brien PE. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes (Lond). 2005;29(9):1048–54.
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(6):755–62.
Guardiano S, Scott JA, Ware JC, et al. The longterm results of gastric bypass on indexes of sleep apnea. Chest. 2003;124(4):1615–19.
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(4):299–302.
Charuzi I, Fraser D, Peiser J, et al. Sleep apnea syndrome in the morbidly obese undergoing bariatric surgery. Gastroenterol Clin North Am. 1987;16(3):517–9.
Charuzi I, Ovnat A, Peiser J, et al. The effect of surgical weight reduction on sleep quality in obesity-related sleep apnea syndrome. Surgery. 1985;97(5):535–8.
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(1):112–5.
Pillar G, Peled R, Lavie P. Recurrence of sleep apnea without concomitant weight reduction increase 7.5 years after weight reduction surgery. Chest. 1994;106(6):1702–4.
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.
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.
Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of OSA after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–8.
Greenburg DL, Lettieri CJ, Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122(6):535–42.
Ravesloot MJ, de Vries N. Reliable calculation of the efficacy of non-surgical and surgical treatment of obstructive sleep apnea revisited. Sleep. 2011;34(1):105–10.
Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. Proc Am Thorac Soc. 2008;5(2):173–8.
Elshaug AG, Moss JR, Southcott AM, et al. Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. Sleep. 2007;30(4):461–7.
Kezirian EJ, Malhotra A, Goldberg AN, et al. Changes in obstructive sleep apnea severity, biomarkers, and quality of life after multilevel surgery. Laryngoscope. 2010;120(7):1481–8.
Kezirian EJ, Goldberg AN. Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based review. Arch Otolaryngol Head Neck Surg. 2006;132(2):206–13.
Lankford AD, Proctor CD, Richard R. Continuous positive airway pressure changes in bariatric surgery patients undergoing rapid weight loss. Obes Surg. 2005;15(3):336–41.
Dixon JB, Schachter LM, O’Brien PE, et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;208(11):1142–9.
Maciel Santos ME, Rocha NS, Laureano Filho JR, et al. Obstructive sleep apnea–hypopnea syndrome—the role of bariatric and maxillofacial surgeries. Obes Surg. 2009;19:796–801.
Hallowell PT, Stellato TA, Schuster M, et al. Potentially life-treatment sleep apnea is unrecognized without aggressive evaluation. Am J Surg. 2007;193:364–7.
O’Brien P. Is weight loss more successful after gastric bypass than gastric banding for obese patients? Nat Clin Pract Gastroenterol Hepatol. 2009;6(3):136–7.
Compher CW, Hanlon A, Kang Y, et al. Attendance at clinical visits predicts weight loss after gastric bypass surgery. Obes Surg. 2012;22(6):927–34.
Ryan CF, Lowe A, Li D, et al. Magnetic resonance imaging of the upper airway in obstructive sleep apnea before and after chronic nasal continuous positive airway pressure therapy. Am Rev Respir Dis. 1991;144(4):939–44.
Acknowledgments
Many thanks to the contribution of P.M.M. Sickinger, project manager at the Amsterdam Obesity Centre of the Sint Lucas Andreas Ziekenhuis.
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No external funding was used for this study.
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The authors do not have any commercial associations that might be a conflict of interest in relation to this article.
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Ravesloot, M.J.L., Hilgevoord, A.A.J., van Wagensveld, B.A. et al. Assessment of the Effect of Bariatric Surgery on Obstructive Sleep Apnea at Two Postoperative Intervals. OBES SURG 24, 22–31 (2014). https://doi.org/10.1007/s11695-013-1023-y
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DOI: https://doi.org/10.1007/s11695-013-1023-y