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Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea

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Abstract

Introduction

Morbid obesity and obstructive sleep apnea (OSA) interact at an inflammatory level. Bariatric surgery reduces inflammatory responses associated with obesity. Heme oxygenase-1 (HO-1) is an enzyme with anti-inflammatory properties, which might be increased in morbid obesity or OSA. We studied morbidly obese patients with OSA to determine: (a) HO-1 plasma concentrations according to OSA severity and their relationship with insulin resistance and inflammation and (b) the impact of bariatric surgery on HO-1 and parameters of insulin resistance and inflammation.

Material and Methods

We analyzed the homeostasis model insulin resistance index (HOMA) and plasma concentrations of HO-1, tumor necrosis factor alpha, interleukin-6, interleukin-1-beta, C reactive protein (CRP), and adiponectin according to polysomnography findings in 66 morbidly obese patients before bariatric surgery and 12 months after surgery.

Results

Before surgery, HO-1 plasma concentrations were similar in three groups of patients with mild, moderate, and severe OSA, and correlated with HOMA (r = 0.27, p = 0.02). Twelve months after surgery, low-grade inflammation and insulin resistance had decreased in all the groups, but HO-1 plasma concentration had decreased only in the severe OSA group (p = 0.02). In this group, the reduction in HO-1 correlated with a reduction in CRP concentrations (r = 0.43, p = 0.04) and with improved HOMA score (r = 0.37, p = 0.03).

Conclusions

Bariatric surgery decreases HO-1 concentrations in morbid obesity with severe OSA, and this decrease is associated with decreases in insulin resistance and in inflammation.

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Acknowledgements

We thank Belén Pons for help with informatics, Jordi Real for statistical analysis, and David Torrents for help in preparing the manuscript.

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Authors and Affiliations

  1. Endocrinology and Nutrition Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, c/ Parc Taulí no 1, 08208, Sabadell, Barcelona, Spain

    Raquel Tirado, Mercedes Rigla, Rocío Pareja, Marta Hurtado & Assumpta Caixàs

  2. Pneumology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, c/ Parc Taulí no 1, 08208, Sabadell, Barcelona, Spain

    Maria José Masdeu

  3. Pneumology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Ciber de Enfermedades Respiratorias-Ciberes, c/ Parc Taulí no 1, 08208, Sabadell, Barcelona, Spain

    Laura Vigil

  4. Surgery Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, c/ Parc Taulí no 1, 08208, Sabadell, Barcelona, Spain

    Alexis Luna & Pere Rebasa

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  1. Raquel Tirado
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Correspondence to Assumpta Caixàs.

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This study was supported by Beques Taulí de Recerca i Innovació 2014/005 Institut d’Investigació i Innovació Parc Taulí (I3PT).

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The authors declare that informed consent was obtained from all individual participants included in the study.

Statement of Ethics

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The study protocol was approved by the Institutional Ethics Committee.

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Tirado, R., Masdeu, M.J., Vigil, L. et al. Impact of Bariatric Surgery on Heme Oxygenase-1, Inflammation, and Insulin Resistance in Morbid Obesity with Obstructive Sleep Apnea. OBES SURG 27, 2338–2346 (2017). https://doi.org/10.1007/s11695-017-2635-4

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