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Published in: Obesity Surgery 1/2014

01-01-2014 | Original Contributions

Assessment of the Effect of Bariatric Surgery on Obstructive Sleep Apnea at Two Postoperative Intervals

Authors: M. J. L. Ravesloot, A. A. J. Hilgevoord, B. A. van Wagensveld, N. de Vries

Published in: Obesity Surgery | Issue 1/2014

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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.
Literature
1.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
2.
go back to reference 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.PubMedCentralPubMedCrossRef 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.PubMedCentralPubMedCrossRef
3.
go back to reference Summers CL, Stradling JR, Baddeley RM. Treatment of sleep apnoea by vertical gastroplasty. Br J Surg. 1990;77(11):1271–2.PubMedCrossRef Summers CL, Stradling JR, Baddeley RM. Treatment of sleep apnoea by vertical gastroplasty. Br J Surg. 1990;77(11):1271–2.PubMedCrossRef
4.
go back to reference Rasheid S. Gastric bypass is an effective treatment for OSA in patients with clinically significant obesity. Obes Surg. 2003;13(1):58–61.PubMedCrossRef Rasheid S. Gastric bypass is an effective treatment for OSA in patients with clinically significant obesity. Obes Surg. 2003;13(1):58–61.PubMedCrossRef
5.
go back to reference 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.PubMed 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.PubMed
6.
go back to reference 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 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
7.
go back to reference Varela JE, Hinojosa MW, Nguyen NT. Resolution of obstructive sleep apnea after laparoscopic gastric bypass. Obes Surg. 2007;17(10):1279–82.PubMedCrossRef Varela JE, Hinojosa MW, Nguyen NT. Resolution of obstructive sleep apnea after laparoscopic gastric bypass. Obes Surg. 2007;17(10):1279–82.PubMedCrossRef
8.
go back to reference 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.PubMed 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.PubMed
9.
go back to reference 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.CrossRef 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.CrossRef
10.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
11.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
12.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
13.
go back to reference 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.PubMed 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.PubMed
14.
go back to reference 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.PubMed 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.PubMed
15.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
16.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
17.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
18.
go back to reference 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 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
19.
go back to reference Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of OSA after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–8.PubMed Lettieri CJ, Eliasson AH, Greenburg DL. Persistence of OSA after surgical weight loss. J Clin Sleep Med. 2008;4(4):333–8.PubMed
20.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
21.
go back to reference 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.PubMed 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.PubMed
22.
go back to reference 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.PubMedCentralPubMedCrossRef 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.PubMedCentralPubMedCrossRef
23.
go back to reference 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.PubMed 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.PubMed
24.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
25.
go back to reference Kezirian EJ, Goldberg AN. Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based review. Arch Otolaryngol Head Neck Surg. 2006;132(2):206–13.PubMedCrossRef Kezirian EJ, Goldberg AN. Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based review. Arch Otolaryngol Head Neck Surg. 2006;132(2):206–13.PubMedCrossRef
26.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
27.
go back to reference 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.CrossRef 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.CrossRef
28.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
29.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
30.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
31.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
32.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
Metadata
Title
Assessment of the Effect of Bariatric Surgery on Obstructive Sleep Apnea at Two Postoperative Intervals
Authors
M. J. L. Ravesloot
A. A. J. Hilgevoord
B. A. van Wagensveld
N. de Vries
Publication date
01-01-2014
Publisher
Springer US
Published in
Obesity Surgery / Issue 1/2014
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-013-1023-y

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