Top

Published in:

01-11-2018 | Original Contributions

Endothelial Function of Patients with Morbid Obesity Submitted to Roux-en-Y Gastric Bypass With and Without Obstructive Sleep Apnea-Hypopnea Syndrome

Authors: Ana Cristina de Assunção Machado, Antonio Marcos Vargas da Silva, Luis Ulisses Signori, Glauco da Costa Alvarez, Claudio Corá Mottin

Published in: Obesity Surgery | Issue 11/2018

Abstract

Background

Obesity is associated with obstructive sleep apnea-hypopnea syndrome (OSA) and both induce endothelial dysfunction. However, the effect of OSA on endothelial function after bariatric surgery has not been investigated yet.

Objectives

This study aims to evaluate the impact of weight loss on endothelial function in patients with and without obstructive sleep apnea (OSA) in the first 6 months after bariatric surgery.

Setting

This study was conducted at a university hospital, in Brazil.

Methods

The sample consisted of 56 patients homogeneously divided into groups with and without OSA. All patients underwent Roux-en-Y gastric bypass (RYGB), and the diagnosis of OSA was performed by polysomnography. The patients were evaluated preoperatively and 6 months after surgery. The evaluations included anthropometric measures, electrical bioimpedance, clinical symptoms of OSA, and endothelial function (flow-mediated dilation). RYGB improved the anthropometric, bioimpedance, and endothelial function results in both groups.

Results

Patients presented a significant clinical improvement in OSA symptoms throughout the study. However, patients with OSA had an improvement in the endothelial function 2.5% lower (p < 0.001) than patients without APNEA syndrome.

Conclusion

This study demonstrates that the existence of OSA prior to bariatric surgery interferes in the improvement of endothelial function.

Ashrafian H, Le Roux CW, Rowland SP, et al. Metabolic surgery and obstructive sleep apnoea: the protective effects of bariatric procedures. Thorax. 2012;67:442–9.CrossRefPubMed

Garvey JF, Pengo MF, Drakatos P, et al. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis. 2015;7:920–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26101650 PubMedCentralPubMed

Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136–43. Available from: http://pats.atsjournals.org/cgi/doi/10.1513/pats.200709-155MG CrossRefPubMedPubMedCentral

Neilan TG, Farhad H, Dodson JA, et al. Effect of sleep apnea and continuous positive airway pressure on cardiac structure and recurrence of atrial fibrillation. J Am Heart Assoc [Internet]. 2013;2:e000421. Available from: http://jaha.ahajournals.org/cgi/doi/10.1161/JAHA.113.000421

Elder KA, Wolfe BM. Bariatric surgery: a review of procedures and outcomes. Gastroenterology. 2007;132:2253–71.CrossRefPubMed

Maggard MA, Shugarman LR, Suttorp M, et al. Clinical guidelines meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:542–58.CrossRef

Sjostrom L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefPubMed

Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934. Available from: http://www.bmj.com/cgi/doi/10.1136/bmj.f5934 CrossRefPubMedPubMedCentral

Owan T, Avelar E, Morley K, et al. Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study. J Am Coll Cardiol. 2011;57:732–9. Elsevier Inc.; Available from:. https://doi.org/10.1016/j.jacc.2010.10.017.CrossRefPubMedCentralPubMed

10.

Sjoström L, Narbro K, Sjoström D, et al. New England Journal. New Engl J Med. 2007;357:741–52.CrossRefPubMed

11.

Vanhoutte PM, Tang EHC. Endothelium-dependent contractions: when a good guy turns bad! J Physiol. 2008;586:5295–304.CrossRefPubMedPubMedCentral

12.

Poredos P, Jezovnik MK. Testing endothelial function and its clinical relevance. J Atheroscler Thromb. 2013;20:1–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22972428 CrossRefPubMed

13.

Thijssen DHJ, Black MA, Pyke KE, et al. Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. AJP Hear Circ Physiol. 2011;300:H2–12. Available from: http://ajpheart.physiology.org/cgi/doi/10.1152/ajpheart.00471.2010 CrossRef

14.

Xu Y, Arora RC, Hiebert BM, et al. Non-invasive endothelial function testing and the risk of adverse outcomes: a systematic review and meta-analysis. Eur Hear J Cardiovasc Imaging. 2014;15:736–46. Available from: https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jet256 CrossRef

15.

Gokce N, Vita JA, Mcdonnell M, et al. Effect of medical and surgical weight loss on endothelial vasomotor function in obese patients. Am J Cardiol. 2005;95:266–8. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15642566 CrossRefPubMed

16.

Azuma M, Chihara Y, Yoshimura C, et al. Association between endothelial function (assessed on reactive hyperemia peripheral arterial tonometry) and obstructive sleep apnea, visceral fat accumulation, and serum adiponectin. Circ J. 2015;79:1381–9. Available from: https://www.jstage.jst.go.jp/article/circj/79/6/79_CJ-14-1303/_article CrossRefPubMed

17.

Marshall NS, Wong KKH, Liu PY, et al. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31:1079–85.CrossRefPubMedPubMedCentral

18.

Jelic S, Padeletti M, Kawut SM, et al. Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation. 2008;117:2270–8.CrossRefPubMedPubMedCentral

19.

Chung S, Yoon I-Y, Shin Y-K, et al. Endothelial dysfunction and C-reactive protein in relation with the severity of obstructive sleep apnea syndrome. Sleep J Sleep Sleep Disord Res. 2007;30:997–1001. Available from: http://ezproxy.lib.uh.edu/login?url= http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2007-19285-008&site=ehost-live\n http://iyoon@snu.ac.kr

20.

Itzhaki S, Lavie L, Pillar G, et al. Endothelial dysfunction in obstructive sleep apnea measured by peripheral arterial tone response in the finger to reactive hyperemia. Sleep. 2005;28:594–600.CrossRefPubMed

21.

Ashrafian H, Le Roux CW, Darzi A, et al. Effects of bariatric surgery on cardiovascular function. Circulation. 2008;118:2091–102.CrossRefPubMed

22.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. J Am Med Assoc. 2004;292:1724–37.CrossRef

23.

Sturm W, Tschoner A, Engl J, et al. Effect of bariatric surgery on both functional and structural measures of premature atherosclerosis. Eur Heart J. 2009;30:2038–43.CrossRefPubMed

24.

Oyama JI, Nagatomo D, Yoshioka G, et al. The relationship between neutrophil to lymphocyte ratio, endothelial function, and severity in patients with obstructive sleep apnea. J Cardiol. 2016;67:295–302. https://doi.org/10.1016/j.jjcc.2015.06.005.CrossRefPubMed

25.

Murray JW. Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res. 2000;9:5–11.CrossRef

26.

Bertalazi AN, Fagones SC, Hoff LS, et al. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. 2009;35:839–45.CrossRef

27.

Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument psychiatric practice and research. Psychiatry Res. 1989;28:193–213.CrossRefPubMed

28.

Kushida C, Littner M, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28:499–521.CrossRefPubMed

29.

Epstein LJ, Kristo D, Strollo P, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–76.PubMed

30.

Sateia MJ. International classification of sleep disorders-third edition highlights and modifications. Chest. 2014;146:1387–94. https://doi.org/10.1378/chest.14-0970.CrossRefPubMed

31.

Corretti MC, Anderson TJ, Benjamin EJ, et al. Guidelines for the ultrasound assessment of flow-mediated vasodilation of the brachial artery. J Am Coll Cardiol. 2002;39:257–65.CrossRefPubMed

32.

Cruz JM, Hauck M, Cardoso Pereira AP, et al. Effects of different therapeutic ultrasound waveforms on endothelial function in healthy volunteers: a randomized clinical trial. Ultrasound Med Biol. 2016;42:471–80. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0301562915005888 CrossRefPubMed

33.

Quintas-Neves M, Preto J, Drummond M. Assessment of bariatric surgery efficacy on obstructive sleep apnea (OSA). Rev Port Pneumol. 2016;22:331–6.PubMed

34.

Simpson L, Mukherjee S, Mn C, et al. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. Sleep. 2010;33:467–74. Available from: http://ezproxy.usherbrooke.ca/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105174268&site=ehost-live CrossRefPubMedPubMedCentral

35.

García G, Bunout D, Mella J, et al. Bariatric surgery decreases carotid intima-media thickness in obese subjects. Nutr Hosp. 2013;28:1102–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23889627 PubMed

36.

Valenta I, Dilsizian V, Quercioli A, et al. Impact of obesity and bariatric surgery on metabolism and coronary circulatory function topical collection on nuclear cardiology. Curr Cardiol Rep. 2014;16:1–9.CrossRef

37.

Heneghan HM, Meron-Eldar S, Brethauer SA, et al. Effect of bariatric surgery on cardiovascular risk profile. Am J Cardiol. Elsevier Inc. 2011;108:1499–507. https://doi.org/10.1016/j.amjcard.2011.06.076.CrossRefPubMed

38.

Kong D, Qin Z, Wang W, et al. Effect of obstructive sleep apnea on carotid artery intima media thickness related to inflammation. Clin Invest Med. 2017;40:E25–33.CrossRefPubMed

39.

Lavie L. Oxidative stress in obstructive sleep apnea and intermittent hypoxia - revisited - the bad ugly and good: implications to the heart and brain. Sleep Med Rev. 2015;20:27–45. Elsevier Ltd. Available from:. https://doi.org/10.1016/j.smrv.2014.07.003.CrossRefPubMed

Title: Endothelial Function of Patients with Morbid Obesity Submitted to Roux-en-Y Gastric Bypass With and Without Obstructive Sleep Apnea-Hypopnea Syndrome
Authors: Ana Cristina de Assunção Machado
Antonio Marcos Vargas da Silva
Luis Ulisses Signori
Glauco da Costa Alvarez
Claudio Corá Mottin
Publication date: 01-11-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 11/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-018-3403-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Endothelial Function of Patients with Morbid Obesity Submitted to Roux-en-Y Gastric Bypass With and Without Obstructive Sleep Apnea-Hypopnea Syndrome

Abstract

Background

Objectives

Setting

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objectives

Setting

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2018

Biography: Kamal Mahawar

Left Gastric Artery Embolization for Weight Loss—a Dead-End Procedure

Comparative Characteristics of Patients with Type 2 Diabetes Mellitus Treated by Bariatric Surgery Versus Medical Treatment: a Multicentre Analysis of 277,862 Patients from the German/Austrian DPV Database

Robotic Versus Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity: a Systematic Review and Meta-Analysis

No Difference in Ghrelin-Producing Cell Expression in Obese Versus Non-obese Stomach: a Prospective Histopathological Case-Control Study

Changes in Bone Mineral Density Following Weight Loss Induced by One-Anastomosis Gastric Bypass in Patients with Vitamin D Supplementation