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01-10-2011 | Clinical Research

Does Surgically Induced Weight Loss Improve Daytime Sleepiness?

Authors: Jon-Erik Cleophas Holty, Neeta Parimi, Michael Ballesteros, Terri Blackwell, Paul T. Cirangle, Gregg H. Jossart, Nicole D. Kimbrough, Jennifer M. Rose, Katie L. Stone, Dena M. Bravata

Published in: Obesity Surgery | Issue 10/2011

Abstract

Morbid obesity is associated with excessive daytime sleepiness and reduced health-related quality of life. We prospectively evaluated the pre- and postoperative responses of bariatric surgery recipients with the Epworth Sleepiness Scale (ESS) and the Short Form-12. Participants (n = 223; 79% women) with a mean body mass index (BMI) and ESS of 44.8 ± 7.9 kg/m² and 7.9 ± 4.5, respectively, received a vertical gastrectomy (76%) or Roux-en-Y gastric bypass (12%). Preoperatively, 30% of patients complained of excessive daytime sleepiness (ESS > 10). Patients with preoperative excessive daytime sleepiness were more obese (p = 0.002), had higher fasting glucose levels (p = 0.02), more likely to have a diagnosis of sleep-disordered breathing (p < 0.001), report snoring (p < 0.001), and had lower health-related quality of life measures particularly physical function (p < 0.001), depression (p = 0.006), and sexual satisfaction (p = 0.04) than non-sleepy patients. At 12-months postoperatively, most patients experienced a significant reduction in BMI (28.6 ± 5.5 kg/m², p < 0.001) and excessive daytime sleepiness (mean ESS 5.3 ± 3.3, p < 0.001). Patients with a clinically relevant improvement in the ESS at 12-months post-operatively had greater improvements in physical function (p = 0.009) and snoring (p = 0.010) and were more likely still using positive airway pressure therapy (p = 0.032) than patients without a clinically relevant improvement. Statistically and clinically significant improvements in all health-related quality of life measures were noted at 24 months. Bariatric surgery is associated with dramatic weight loss and improvements in physical functioning and daytime sleepiness.

Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people. Obes Surg. 2003;13:329–30.PubMedCrossRef

Flegal KM, Carrol MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288:1723–7.PubMedCrossRef

Mokdad AH, Bowman BA, Fe S, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286(10):1195–200.PubMedCrossRef

Dansinger ML, Tatsioni A, Wong JB, et al. Meta-analysis: the effect of dietary counseling for weight loss. Ann Int Med. 2007;147:41–50.PubMed

Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.PubMedCrossRef

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRef

Dixon JB, Schachter L, O'Brien PE. Sleep disturbance and obesity. Changes following surgically induced weight loss. Arch Intern Med. 2001;161:102–6.PubMedCrossRef

Bixler EO, Vgontzas AN, Lin HM, et al. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes and depression. J Clin Endocrinol Metab. 2005;90(8):4510–5.PubMedCrossRef

Dixon JB, Dixon ME, Anderson ML, et al. Daytime sleepiness in the obese: not as simple as obstructive sleep apnea. Obesity. 2007;15(10):2504–11.PubMedCrossRef

10.

Resta O, Foschino Barbaro MP, Bonfitto P, et al. Low sleep quality and daytime sleepiness in obese patients without obstructive sleep apnoea syndrome. J Intern Med. 2003;253(5):536–43.PubMedCrossRef

11.

Vgontzas AN, Bixler EO, Tan TL, et al. Obesity without sleep apnea is associated with daytime sleepiness. Arch Intern Med. 1998;158(12):1333–7.PubMedCrossRef

12.

Vgontzas AN, Pejovic S, Zoumakis E, et al. Hypothalamic-pituitary-adrenal axis activity in obese men with and without sleep apnea: effects of continuous positive airway pressure therapy. J Clin Endocrinol Metab. 2007;92(11):4199–207.PubMedCrossRef

13.

Barcelo A, Barbe F, de la Pena M, et al. Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax. 2008;63(11):946–50.PubMedCrossRef

14.

Sharma SK, Kumpawat S, Goel A, et al. Obesity, and not obstructive sleep apnea, is responsible for metabolic abnormalities in a cohort with sleep-disordered breathing. Sleep Med. 2007;8(1):12–7.PubMedCrossRef

15.

Vgontzas AN, Papanicolaou DA, Bixler EO, et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab. 2000;85(3):1151–8.PubMedCrossRef

16.

Lim W, Hong S, Nelesen R, et al. The association of obesity, cytokine levels, and depressive symptoms with diverse measures of fatigue in healthy subjects. Arch Intern Med. 2005;165(8):910–5.PubMedCrossRef

17.

Kapsimalis F, Basta M, Varouchakis G, et al. Cytokines and pathological sleep. Sleep Med. 2008;9(6):603–14.PubMedCrossRef

18.

Vgontzas AN, Lin HM, Papaliaga M, et al. Short sleep duration and obesity: the role of emotional stress and sleep disturbances. Int J Obes. 2008;32(5):801–9.CrossRef

19.

Lyznicki JM, Doege TC, Davis RM, et al. Sleepiness, driving, and motor vehicle crashes. Council on Scientific Affairs, American Medical Association. Jama. 1998;279(23):1908–13.PubMedCrossRef

20.

Newman AB, Spiekerman CF, Enright P, et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group. J Am Geriatr Soc. 2000;48(2):115–23.PubMed

21.

Empana JP, Dauvilliers Y, Dartigues JF, et al. Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study. Stroke. 2009;40(4):1219–24.PubMedCrossRef

22.

Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med. 2002;251(3):207–16.PubMedCrossRef

23.

Lindberg E, Janson C, Svardsudd K, et al. Increased mortality among sleepy snorers: a prospective population based study. Thorax. 1998;53(8):631–7.PubMedCrossRef

24.

Dixon JB, Schachter LM, O'Brien PE. Polysomnography before and after weight loss in obese patients with severe sleep apnea. Int J Obes. 2005;29(9):1048–54.CrossRef

25.

Anonymous. Gastrointestinal surgery for severe obesity. NIH Consens Statement Online. 1991;9(1):1–20.

26.

Wee CC, Davis RB, Hamel MB. Comparing the SF-12 and SF-36 health status questionnaires in patients with and without obesity. Health Qual Life Outcomes. 2008;6:11.PubMedCrossRef

27.

Jenkinson C, Layte R, Jenkinson D, et al. A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med. 1997;19(2):179–86.PubMed

28.

Muller-Nordhorn J, Nolte CH, Rossnagel K, et al. The use of the 12-item short-form health status instrument in a longitudinal study of patients with stroke and transient ischaemic attack. Neuroepidemiology. 2005;24(4):196–202.PubMedCrossRef

29.

Muller-Nordhorn J, Roll S, Willich SN. Comparison of the short form (SF)-12 health status instrument with the SF-36 in patients with coronary heart disease. Heart. 2004;90(5):523–7.PubMedCrossRef

30.

Ware Jr JE, Bayliss MS, Rogers WH, et al. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA. 1996;276(13):1039–47.PubMedCrossRef

31.

Li C, Friedman B, Conwell Y, et al. Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. J Am Geriatr Soc. 2007;55(4):596–602.PubMedCrossRef

32.

Whooley MA, Avins AL, Miranda J, et al. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12(7):439–45.PubMedCrossRef

33.

Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.PubMed

34.

Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep. 1991;14(6):540–5.PubMed

35.

Kapur VK, Baldwin CM, Resnick HE, et al. Sleepiness in patients with moderate to severe sleep-disordered breathing. Sleep. 2005;28(4):472–7.PubMed

36.

Gottlieb DJ, Whitney CW, Bonekat WH, et al. Relation of sleepiness to respiratory disturbance index: the Sleep Heart Health Study. Am J Respir Crit Care Med. 1999;159(2):502–7.PubMed

37.

Punjabi NM, Bandeen-Roche K, Young T. Predictors of objective sleep tendency in the general population. Sleep. 2003;26(6):678–83.PubMed

38.

Knutson KL, Rathouz PJ, Yan LL, et al. Stability of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Questionnaires over 1 year in early middle-aged adults: the CARDIA study. Sleep. 2006;29(11):1503–6.PubMed

39.

Sanford SD, Lichstein KL, Durrence HH, et al. The influence of age, gender, ethnicity, and insomnia on Epworth sleepiness scores: a normative US population. Sleep Med. 2006;7(4):319–26.PubMedCrossRef

40.

Buysse DJ, Hall ML, Strollo PJ, et al. Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med. 2008;4(6):563–71.PubMed

41.

Johns M, Hocking B. Daytime sleepiness and sleep habits of Australian workers. Sleep. 1997;20(10):844–9.PubMed

42.

Parkes JD, Chen SY, Clift SJ, et al. The clinical diagnosis of the narcoleptic syndrome. J Sleep Res. 1998;7(1):41–52.PubMedCrossRef

43.

White J, Cates C, Wright J. Continuous positive airways pressure for obstructive sleep apnoea. Cochrane Database Syst Rev. 2002(2):CD001106.

44.

Kingshott RN, Vennelle M, Coleman EL, et al. Randomized, double-blind, placebo-controlled crossover trial of modafinil in the treatment of residual excessive daytime sleepiness in the sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med. 2001;163(4):918–23.PubMed

45.

Anonymous. Randomized trial of modafinil for the treatment of pathological somnolence in narcolepsy. US Modafinil in Narcolepsy Multicenter Study Group. Ann Neurol. 1998;43(1):88–97.CrossRef

46.

Puhan MA, Suarez A, Lo Cascio C, et al. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006;332(7536):266–70.PubMedCrossRef

47.

Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med. 1976;27:465–84.PubMedCrossRef

48.

Overall JE, Ahn C, Shivakumar C, et al. Problematic formulations of SAS PROC.MIXED models for repeated measurements. J Biopharm Stat. 1999;9(1):189–216.PubMedCrossRef

49.

Vinkers DJ, Gussekloo J, Stek ML, et al. Temporal relation between depression and cognitive impairment in old age: prospective population based study. Bmj. 2004;329(7471):881.PubMedCrossRef

50.

MacKinnon DP, Dwyer JH. Estimating mediated effects in prevention studies. Eval Rev. 1993;17(2):144–58.CrossRef

51.

Carmelli D, Bliwise DL, Swan GE, et al. A genetic analysis of the Epworth Sleepiness Scale in 1560 World War II male veteran twins in the NAS-NRC Twin Registry. J Sleep Res. 2001;10(1):53–8.PubMedCrossRef

52.

Carmelli D, Bliwise DL, Swan GE, et al. Genetic factors in self-reported snoring and excessive daytime sleepiness: a twin study. Am J Respir Crit Care Med. 2001;164(6):949–52.PubMed

53.

Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of obstructive sleep apnea after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–8.PubMed

54.

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.PubMedCrossRef

55.

Varela JE, Hinojosa MW, Nguyen NT. Resolution of obstructive sleep apnea after laparoscopic gastric bypass. Obes Surg. 2007;17(10):1279–82.PubMedCrossRef

56.

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.PubMedCrossRef

57.

Rasheid S, Banasiak M, Gallagher SF, et al. Gastric bypass is an effective treatment for obstructive sleep apnea in patients with clinically significant obesity. Obes Surg. 2003;13(1):58–61.PubMedCrossRef

58.

Lessov-Schlaggar CN, Bliwise DL, Krasnow RE, et al. Genetic association of daytime sleepiness and depressive symptoms in elderly men. Sleep. 2008;31(8):1111–7.PubMed

59.

Paudel ML, Taylor BC, Diem SJ, et al. Association between depressive symptoms and sleep disturbances in community-dwelling older men. J Am Geriatr Soc. 2008;56(7):1228–35.PubMedCrossRef

60.

Pallesen S, Nordhus IH, Omvik S, et al. Prevalence and risk factors of subjective sleepiness in the general adult population. Sleep. 2007;30(5):619–24.PubMed

61.

Aloia MS, Arnedt JT, Smith L, et al. Examining the construct of depression in obstructive sleep apnea syndrome. Sleep Med. 2005;6(2):115–21.PubMedCrossRef

62.

Lundt L. Use of the Epworth Sleepiness Scale to evaluate the symptom of excessive sleepiness in major depressive disorder. Gen Hosp Psychiatry. 2005;27(2):146–8.PubMedCrossRef

63.

Resnick HE, Carter EA, Aloia M, et al. Cross-sectional relationship of reported fatigue to obesity, diet, and physical activity: results from the third national health and nutrition examination survey. J Clin Sleep Med. 2006;2(2):163–9.PubMed

64.

Theorell-Haglow J, Lindberg E, Janson C. What are the important risk factors for daytime sleepiness and fatigue in women? Sleep. 2006;29(6):751–7.PubMed

65.

Kim H, Young T, Kim H, et al. Subjective daytime sleepiness: dimensions and correlates in the general population. Sleep. 2005;28(5):625–34.PubMed

66.

Nena E, Tsara V, Steiropoulos P, et al. Sleep-disordered breathing and quality of life of railway drivers in Greece. Chest. 2008;134(1):79–86.PubMedCrossRef

67.

Siccoli MM, Pepperell JC, Kohler M, et al. Effects of continuous positive airway pressure on quality of life in patients with moderate to severe obstructive sleep apnea: data from a randomized controlled trial. Sleep. 2008;31(11):1551–8.PubMed

68.

Welch KC, Scharf SM, Welch KC, et al. Construct validity for the Health Utilities Index in a sleep center. Sleep Breath. 2007;11(4):295–303.PubMedCrossRef

69.

Wang PC, Li HY, Shih TS, et al. Generic and specific quality-of-life measures in Taiwanese adults with sleep-disordered breathing. Otolaryngol Head Neck Surg. 2006;135(3):421–6.PubMedCrossRef

70.

Briones B, Adams N, Strauss M, et al. Relationship between sleepiness and general health status. Sleep. 1996;19(7):583–8.PubMed

71.

Gulbay BE, Acican T, Onen ZP, et al. Health-related quality of life in patients with sleep-related breathing disorders: relationship with nocturnal parameters, daytime symptoms and comorbid diseases. Respiration. 2008;75(4):393–401.PubMedCrossRef

72.

Weaver EM, Kapur V, Yueh B. Polysomnography vs self-reported measures in patients with sleep apnea. Arch Otolaryngol Head Neck Surg. 2004;130(4):453–8.PubMedCrossRef

73.

Karlsson J, Taft C, Ryden A, et al. Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study. Int J Obes. 2007;31(8):1248–61.CrossRef

74.

Mathus-Vliegen EM. Long-term health and psychosocial outcomes from surgically induced weight loss: results obtained in patients not attending protocolled follow-up visits. Int J Obes. 2007;31(2):299–307.CrossRef

75.

Dixon JB, Dixon ME, O'Brien PE. Quality of life after lap-band placement: influence of time, weight loss, and comorbidities. Obes Res. 2001;9(11):713–21.PubMedCrossRef

76.

Karason K, Lindroos AK, Stenlof K, et al. Relief of cardiorespiratory symptoms and increased physical activity after surgically induced weight loss: results from the Swedish Obese Subjects study. Arch Intern Med. 2000;160(12):1797–802.PubMedCrossRef

77.

Baldwin CM, Kapur VK, Holberg CJ, et al. Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study. Sleep. 2004;27(2):305–11.PubMed

78.

Fong SY, Ho CK, Wing YK. Comparing MSLT and ESS in the measurement of excessive daytime sleepiness in obstructive sleep apnoea syndrome. J Psychosom Res. 2005;58(1):55–60.PubMedCrossRef

79.

Chervin RD, Aldrich MS. The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea. Neurology. 1999;52(1):125–31.PubMed

80.

Chervin RD, Aldrich MS, Pickett R, et al. Comparison of the results of the Epworth Sleepiness Scale and the Multiple Sleep Latency Test. J Psychosom Res. 1997;42(2):145–55.PubMedCrossRef

Title: Does Surgically Induced Weight Loss Improve Daytime Sleepiness?
Authors: Jon-Erik Cleophas Holty
Neeta Parimi
Michael Ballesteros
Terri Blackwell
Paul T. Cirangle
Gregg H. Jossart
Nicole D. Kimbrough
Jennifer M. Rose
Katie L. Stone
Dena M. Bravata
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: Obesity Surgery / Issue 10/2011
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-010-0213-0

At a glance: The STEP trials

Springer Medicine

Does Surgically Induced Weight Loss Improve Daytime Sleepiness?

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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