Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 4/2010

01-04-2010 | Clinical Research

Asymptomatic Sleep-disordered Breathing in Premenopausal Women Awaiting Bariatric Surgery

Authors: Albert Lecube, Gabriel Sampol, Patricia Lloberes, Odile Romero, Jordi Mesa, Ferran Morell, Rafael Simó

Published in: Obesity Surgery | Issue 4/2010

Login to get access

Abstract

Background

There is a strong association between sleep-disordered breathing (SDB) and obesity. However, there are no studies addressed to determining the prevalence of SDB in morbidly obese premenopausal women, the most frequent group of patients requiring bariatric surgery. To evaluate the prevalence and characteristics of sleep apnea-hypopnea syndrome (SAHS) and obesity hypoventilation syndrome (OHS) in morbidly obese pre-menopausal women included in a program of bariatric surgery.

Methods

A total of 88 consecutive morbidly obese pre-menopausal women (38.3 ± 8.1 years, body mass index (BMI) 48.0 ± 6.7 kg/m2) being evaluated for bariatric surgery at the outpatient obesity unit of a university hospital were prospectively recruited. SDB examinations included a non-attended respiratory polygraphy, pulmonary function testing, and an awake arterial gasometry. SAHS was defined as an apnea-hypopnea index (AHI) ≥10 events per hour and patients were divided in non-SAHS (AHI <10), mild (AHI: 10–20), moderate (AHI: 21–30), and severe (AHI >30). OHS was defined as the presence of hypercapnia (PaCO2 > 45). Somnolence was evaluated using the Epworth sleepiness scale.

Results

A total of 66 (75.0%) obese patients had SAHS: 25 (28.4%) mild, 14 (15.9%) moderate, and 27 (30.6%) severe. Seven (7.9%) obese patients presented OHS. Excessive daily somnolence was recorded in only 11 (16.6%) of the obese women with SAHS. In multiple regression analysis, BMI was the only variable independently associated with SAHS severity.

Conclusions

Due to its high prevalence and severity, it should be recommended to investigate SDB in all morbidly obese pre-menopausal women awaiting bariatric surgery even in the absence of excessive daytime sleepiness.
Literature
1.
Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–7.CrossRefPubMed
2.
Neira M, de Onis M. The Spanish strategy for nutrition, physical activity and the prevention of obesity. Br J Nutr. 2006;96(Suppl 1):S8–11.PubMed
3.
Pope G, Birkmeyer J, Finlayson S. National trends in utilization and in-hospital outcomes of bariatric surgery. J Gastrointest Surg. 2002;6:855–61.CrossRefPubMed
4.
Lecube A, Fort JM, Baena JA, et al. Initial experience with 150 consecutive gastric bypass: an approach to the learning curve of bariatric procedures. Obes Metab. 2007;3:175–82.
5.
Young T, Skatrud J, Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291:2013–6.CrossRefPubMed
6.
Young T, Peppard PE, Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol. 2005;99:1592–9.CrossRefPubMed
7.
Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84.CrossRefPubMed
8.
Shamsuzzaman AS, Somers VK. Fibrinogen, stroke, and obstructive sleep apnea: an evolving paradigm of cardiovascular risk. Am J Respir Crit Care Med. 2000;162:2018–20.PubMed
9.
Marin JM, Carrizo SJ, Vicente E, et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046–53.PubMed
10.
Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–41.CrossRefPubMed
11.
Marti S, Sampol G, Muñoz X, et al. Mortality in severe sleep apnoea/hypopnoea patients: impact of treatment. Eur Respir J. 2002;20:1511–8.CrossRefPubMed
12.
Berg G, Delaive K, Manfreda J, et al. The use of health-care resources in obesity hypoventilation syndrome. Chest. 2001;120:377–83.CrossRefPubMed
13.
Nowbar S, Burkart KM, Gonzales R, et al. Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome. Am J Med. 2004;116:1–7.CrossRefPubMed
14.
Perez de Llano LA, Golpe R, Ortiz Piquer M, et al. Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome. Chest. 2005;128:587–94.CrossRefPubMed
15.
Engleman HM, Martin SE, Deary IJ, et al. Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax. 1997;52:114–9.CrossRefPubMed
16.
Baldwin CM, Griffith KA, Nieto FJ, et al. The association of sleep-disordered breathing and sleep symptoms with quality of life in the Sleep Heart Health Study. Sleep. 2001;24:96–105.PubMed
17.
George CF. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax. 2001;56:508–12.CrossRefPubMed
18.
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.CrossRefPubMed
19.
Redline S, Kump K, Tishler PV, et al. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med. 1994;149:722–6.PubMed
20.
Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163:608–13.PubMed
21.
Block AJ, Wynne JW, Boysen PG. Sleep-disordered breathing and nocturnal oxygen desaturation in postmenopausal women. Am J Med. 1980;69:75–9.CrossRefPubMed
22.
Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165:1217–39.CrossRefPubMed
23.
Gastrointestinal surgery for severe obesity. National Institutes of Health Conference Statement. Am J Clin Nutr. 1992;55:615S–9.
24.
25.
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005;28:S37–42.CrossRef
26.
Esnaola S, Duran J, Infante-Rivard C, et al. Diagnostic accuracy of a portable device (Mesam IV) in suspected sleep apnoea. Eur Respir J. 1996;9:2597–605.CrossRefPubMed
27.
Lloberes P, Sampol G, Levy G, et al. Influence of setting on unattended respiratory monitoring in the sleep apnoea-hypopnoea syndrome. Eur Respir J. 2001;16:530–4.CrossRef
28.
Quanjer PH, Tammeling GJ, Cotes LE. Lung volumes and forced ventilatory flows. Eur Respir J. 1996;6(suppl 16):41–52.
29.
Roca J, Sanchis J, Agusti-Vidal A, et al. Spirometric reference values from a Mediterranean population. Bull Eur Physiopathol Respir. 1986;22:217–24.PubMed
30.
Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–5.PubMed
31.
Hiestand DM, Britz P, Goldman M, et al. Prevalence of symptoms and risk of sleep apnea in US population: results from the National Sleep Foundation sleep in America 2005 poll. Chest. 2006;130:780–6.CrossRefPubMed
32.
Resta O, Foschino-Barbaro MP, Legari G, et al. Sleep-related breathing disorders, loud snoring and excessive daytime sleepiness in obese subjects. Int J Obes Relat Metab Disord. 2001;25:669–75.CrossRefPubMed
33.
Sloan EP, Shapiro CM. Obstructive sleep apnea in a consecutive series of obese women. Int J Eating Disord. 1995;17:167–73.CrossRef
34.
Shinohara E, Kihara S, Yamashita S, et al. Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects. J Intern Med. 1997;241:11–8.CrossRefPubMed
35.
Guilleminault C, Quera Salva MA, Partinen M, et al. Women and the obstructive sleep apnoea syndrome. Chest. 1998;93:104–9.CrossRef
36.
Krystal A, Edinger J, Wohlgemuth W, et al. Sleep in peri-menopausal and post-menopausal women. Sleep Med Rev. 1998;2:243–53.CrossRefPubMed
37.
Dixon JB, Dixon ME, Anderson ML, et al. Daytime sleepiness in the obese: not as simple as obstructive sleep apnea. Obesity (Silver Spring). 2007;15:2504–11.CrossRef
38.
Pillar G, Lavie P. Psychiatric symptoms in sleep apnea syndrome: effects of gender and respiratory disturbance index. Chest. 1998;114:697–703.CrossRefPubMed
39.
Young T, Hutton R, Finn L, et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med. 1996;156:2445–51.CrossRefPubMed
40.
Pack AI, Maislin G. Who should get treated for sleep apnea? Ann Intern Med. 2001;134:1065–7.PubMed
41.
Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005;99:1998–2007.CrossRefPubMed
42.
Kono M, Tatsumi K, Saibara T, et al. Obstructive sleep apnea syndrome is associated with some components of metabolic syndrome. Chest. 2007;131:1387–92.CrossRefPubMed
43.
Vgontzas AN. Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem. 2008;114:211–23.CrossRefPubMed
44.
Lecube A, Sampol G, Lloberes P, et al. Diabetes is an independent risk factor for severe nocturnal hypoxemia in obese patients. A case-control study. PLoS One. 2009;4:e4692.CrossRefPubMed
45.
Gupta R, Parvizi J, Hanssen AD, et al. Postoperative complication in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case-control study. Mayo Clin Proc. 2001;76:897–905.CrossRefPubMed
46.
Hwang S, Shakir N, Limann B, et al. Association of sleep-disordered breathing with postoperative complications. Chest. 2008;133:1128–34.CrossRefPubMed
Metadata
Title
Asymptomatic Sleep-disordered Breathing in Premenopausal Women Awaiting Bariatric Surgery
Authors
Albert Lecube
Gabriel Sampol
Patricia Lloberes
Odile Romero
Jordi Mesa
Ferran Morell
Rafael Simó
Publication date
01-04-2010
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 4/2010
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-009-0033-2

Other articles of this Issue 4/2010

Obesity Surgery 4/2010 Go to the issue

Clinical Research

Confirmatory Factor Analysis of the Beck Depression Inventory in Obese Individuals Seeking Surgery

Research Article

Injection Port and Connecting Tube Complications after Laparoscopic Adjustable Gastric Banding

Clinical Research

Laparoscopic Gastric Banding Is Safe in Outpatient Surgical Centers

Clinical Research

Circular- vs. Linear-Stapled Gastrojejunostomy in Laparoscopic Roux-En-Y Gastric Bypass

Clinical Report

Long-Term Results of Gastric Bypass Surgery in Morbidly Obese Type 1 Diabetes Patients

Case Report

Endoscopic Gastrostomy After Bariatric Surgery: A Unique Approach